Block 1: Practice Essay Questions and Answers

…By Durga and Sathis, MBBS Batch 32 students (MMMC)

A Project guided by Dr. Satheesha Nayak, Professor of Anatomy, MMMC

1. Classify the joints, giving suitable examples for each type and subtype.
(5 marks)
 Two classes of joints are synarthroses and diarthroses
 Synarthroses do not possess a joint cavity
 Synarthroses are further classified into fibrous and cartilaginous joints
 Diarthroses possess a joint cavity and they are known as synovial joints
a) Fibrous joints are further classified as follows:
Sutures: between bones of skull
Syndesmosis: inferior tibiofibular joint
Gomphosis: root of tooth in its bony socket
b) Cartilaginous joints are further classified as follows
Primary cartilaginous (synchondrosis): costochondral joints
Secondary cartilaginous (symphysis): symphysis pubis

c) Synovial joints are classified based on shape of articular processes as follows:

SUBTYPE EXAMPLE
Ball and socket
Hip joint
(spheroidal)
Saddle (sellar) Sternoclavicular
Condylar /bicondylar Temporomandibular
Ellipsoid Wrist joint
Hinge Elbow joint
Superior and inferior
Pivot / trochoid
radioulnar
Plane Sacroiliac joint

Classification of synovial joints based on the number of axes of movement is as follows:

 Uniaxial: elbow joint, interphalangeal joints
 Biaxial: wrist joint, metacarpophalangeal joints

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  Multiaxial: shoulder joint, hip joint
Classification of the synovial joints based on the number of bones and presence of intra-
articular structures is as follows:
 Simple joint: only two bones participate in the joint. Ex: shoulder joint, hip joint
 Compound joint: More than one bone take part in the joint. Ex: elbow joint, wrist
joint
 Complex joints: Possess intra-articular structure such as disc or menisci. Ex:
temporomandibular joint, knee joint

2. Describe with the help of a labelled diagram, the transverse section of compact
bone as seen under the light microscope.
(5 marks)

Transverse section of bone:

 Has periostium and endosteum
 Periosteum is the outer covering with two layers; outer fibrogenic layer and inner
osteogenic layer
 Fibrogenic layer is made up of collagen fibres and osteogenic layer is made up of
osteoblast cells
 Endosteum is a thin, soft layer of tissue lining the medullary cavity of bones

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  Compact bone has a solid, mineralised matrix containing collagen fibres and calcium
hydroxyapatite crystals
 The matrix is arranged in the form of 3 types of lamellae in the compact bone:
 Outer and inner circumferential lamellae (just deep to the
periosteum and endosteum respectively)
 Concentric lamellae (around the Haversian canals)
 Interstitial lamellae (in between the Haversian canal system)
 Lacunae which are spaces between lamellae and are occupied by osteocytes
 Haversian and Volkmann’s canal are found in the compact bone and they carry blood
vessels and nerves
 Haversian canals run longitudinally and Volkmann’s canals run transversly

3. A patient presents with loss of skin sensations for medial 1½ finger on both palmar
and dorsal aspects of his left hand. He could not grip a paper between his middle
and ring fingers and also unable to flex the terminal phalanges of ring finger and
little finger also. With your anatomy knowledge,
a. Name the nerve involved in this case and mention its root value.
b. Give reasons for:
i. Loss of sensation
ii. Loss of ability to grip the paper
iii. Loss of ability to flex the terminal phalanx
(2+3=5 marks)
a) Ulnar nerve (roote value: C7, C8,TI)

b) i. Sensation from the dorsal and palmar aspects of medial part of the hand are carried by
ulnar nerve. Hence there is loss of sensation.
ii. Loss of ability to grip the paper is due to the paralysis of palmar interossei. The ulnar nerve
supplies palmar interossei which allow adduction of fingers
iii. The flexor digitorum profundus muscle flexes the terminal phalanges of the medial four
digits. Medial part of flexor digitorum profundus that flexes the terminal phalanges of ring
and little finger is supplied by ulnar nerve. Hence when ulnar nerve is injured, there will be
loss of ability to flex terminal phalanges of little and ring fingers.

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4. Describe the extent, course, branches and anterior relations of the brachial artery.
(1+1½+1+1½=5 marks)
Brachial artery
 Extends from lower border of teres major muscle to a point in front of elbow at the
level of the neck of radius
 Course: - begins as the continuation of axillary artery
-runs downwards and laterally in front of the arm and crosses elbow joint
-ends at the level of neck of radius in cubital fossa by dividing into ulnar and
radial artery

 Branches: muscular
Profunda brachii artery
Superior ulnar collateral artery
Nutrient artery
Inferior ulnar collateral artery
Radial artery
Ulnar artery

 Anterior relations: Median nerve (crossed in middle of arm frm lateral to medial side)
Bicipital aponeurosis (in front of elbow)
Median cubital vein (in front of elbow)
5. Name the structures forming each of the boundaries (walls) of axilla. Mention its
contents
(3+2=5 marks)
Boundaries:
 Anterior wall: Pectoralis major
Clavipectoral fascia
Pectoralis minor

 Medial wall: upper 4 ribs with their intercostals muscles

Upper part of Serratus anterior

 Lateral wall: upper part of shaft of humerus at region of bicipital groove

Coracobrachialis and short head of biceps brachii

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 Contents: Axillary artery
Axillary vein
Infraclavicular part of brachial plexus
Axillary lymph nodes
Long thoracic nerve
Intercostobrachial nerve
Axillary fat and areolar tissue

6. Harish, a 20-year old athlete, was brought to the hospital following an accident
while running. His knee was twisted while it was bent. The doctor suspected a case
of lateral meniscal tear and conducted further investigations to confirm his
suspicions.
a. Name any two functions of the menisci.
b. Describe briefly the mechanism of locking and unlocking of the knee joint.
(2+3=5 marks)
a. Functions of menisci:
They help in lubricating knee joint cavity by spreading the synovil fluid
They act as shock absorbers

b) Locking:
 Medial rotation of femur during last stages of extension when the foot is on
the ground is called locking
 It brings the perfect alignment between femur and tibia (close pack position)
so that a person can stand without straining many muscles at the knee
 Locking is done by vastus medialis part of quadriceps femoris

Unlocking:
 Lateral rotation of femur during initial stages of flexion of the knee when the
foot is on the ground is called unlocking
 Unlocking will make the knee free for movement
 It is done by popliteus muscle

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7. Give the root value, branches & complete distribution of the femoral nerve.
(1+1+2=5 marks)
Femoral nerve:
 Root value: dorsal division of anterior primary rami of spinal nerves L2,L3,L4

 Branches and distributions :

 At first, femoral nerve supplies iliacus and pectenius muscles (when it is in the pelvis)
 It divides into anterior and posterior divisions in the femoral triangle
 Following are the branches and their distribution
Muscular branches:
 Anterior division supplies sartorius
 Posterior division supplies rectus femoris, 3 vasti and
Articularis genu (through nerve to vastus intermedius)
Cutaneous branches:
 anterior division gives intermediate and medial cutaneous nerves of thigh
 Posterior division gives saphenous nerve
Articular branches:
 To hip joint by nerve to rectus femoris
 To knee joint by nerve to 3 vasti
Vascular branches:
 To femoral artery

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8. A young woman came to the hospital for an OB-GYN examination complaining of
intense abdominal pain and vaginal bleeding. She explained to the doctor that she
had missed her last two menstrual periods and thought she might be pregnant. The
doctor suspected that this might be a case of ectopic pregnancy.
a. What is ectopic pregnancy? What are the possible sites of this kind of
pregnancy?
b. Write briefly about the stages of the menstrual cycle.
(2+3=5 marks)

a) It is the pregnancy resulted by implantation occuring in sites other than fundus of uterus
Possible sites: Uterine cervix, ovary, rectouterine pouch, other parts of peritoneal cavity and
uterine tube

b) Stages of menstrual cycle:

 Menstrual phase:-bleeding or hemorrhagic phase
-superficial 2/3 of endometrium is shed off
-these parts of endometrium are shed of by the blood coming from
the ruptured endometrial arteries

 Proliferative phase: - re-epithelialisation of endometrium takes place

-remaining basal portions of uterine glands proliferate to reform
the epithelium of endometrium
-endometrium thickens

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 -uterine glands elongate
-ovulation occurs during this stage on 14th day
-after ovulation corpus luteum forms and secretes progesterone
-progestrone causes endometrium to enter secretory phase

 Secretory phase: -depends on progesterone and estrogen secreted by corpus luteum

-endometrium walls become thicker and have 3 layers
(deep stratum basale, middle sratum spongiosum, superficial
stratum compactum)
-uterine arteries become large and tortuous and are called spiral
arteries
-uterine glands are further elongated and tortuous and start secreting
fluid called ‘uterine milk’ to nourish the embryo
-if fertilisation does not occur, then corpus luteum degenerates
- Progestrerone secretion decreases causing the endometrium wall
to shed again

9. Describe the notochord under the following headings:

a. Formation
b. Function
c. Fate
(3+1+1=5 marks)
a) Formation:
-formed in 3rd week of IUL
-begin with formation solid process of cells called notochordal process
-it is formed by epiblast cells that invaginate from primitive node to prechordal
plate
-amniotic fluid enters the notochordal process and makes notochordal canal
-then floor of notochordal canal and endoderm in contact with it degenerates
-this forms a communication between notochordal canal and yolk sac
-the communicating canal is called neurenteric canal
-the canal then becomes flat and is called notochordal plate
-the plate then folds on itself to form a solid process and forms definitive notochord

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 b) Functions: -provides support for embryonic disc and determines the central axis of
embryo
-stimulates overlying ectoderm to form neural tube

c) Fate: most parts degenerates and the remaining parts form nucleus pulposus of
intervertebral disc and its cranial part forms apical ligament of dense of axis
vertebra

10. Write a brief note on the formation and structures developing from the somites.
(1+4=5 marks)
Formation:
By the beginning of the 3rd week, the paraxial mesoderm becomes organized into
brick like unites or segments called ' somitomeres ' or ' somites '. The formation of the
somites begins in the cephalic region of the embryo and proceeds craniocaudally. The
first pair of somites appears on the 20th day of development. From here,
approximately 3 pairs of somites appear per day till the end of 5th week. At the end, a
total number of 42 44 pairs are formed. There will be 4 occipital, 7 cervical, 12
thoracic, 5 lumbar, 5 sacral and 8 10 coccygeal pairs. Later, first occipital and 5 7
coccygeal somites disappear. The period of IUL where the somites are formed is
called 'somite period' and during this period, the age of the embryo could be given by
counting the somites. The somites give rise to the axial skeleton of the body.

Structures derived from somite:

The somites start to differentiate in the 4th week of the intrauterine life. Initially there
lies a small cavity in the centre of the somite. The dorsolateral part of the somite is
called 'dermomyotome' and the ventromedial part of the somite is called 'sclerotome'.
The dermomyotome divides into two parts. The peripheral part is called 'dermatome'
and central part is called 'myotome'. The dermatome forms the dermis of the skin. It
will fuse with the overlying ectoderm to form the skin. The myotome forms the
segmental muscles which are attached to the vertebral column. The cells of the
sclerotome move medially and cover the notochord and the neural tube. These cells of
the sclerotome will form the vertebral column. Only the 'nucleus pulposus' part of the

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 intervertebral disc is formed by the notochord. All the other elements of the vertebral
column are formed by the sclerotome

11. Name the joints of lower limb. Mention the type and subtype of each of them.
(5 marks)
JOINTS TYPE SUBTYPE
Hip joint Synovial Ball and socket
Compound synovial Condylar (femoro-tibial)
Knee joint
saddle (femoro-patellar)
Ankle joint Synovial Hinge

Superior tibiofibular Synovial Plane

joint

Middle tibiofibular Fibrous Syndesmosis

Inferior tibiofibular Fibrous Syndesmosis
Talocalcanean joint Synovial Plane
Talocalcaneonavicular Synovial Ball and socket
Calcaneocuboid Synovial Saddle
Intertarsal Synovial plane
Tarsometatarsal Synovial Plane
Metatarsophalangeal Synovial Condylar
Interphalangeal Synovial Hinge

12. Define the following terms:

a. Antagonists
b. Ganglion
c. Bursa
d. Epiphysis
e. Sesamoid bone
f. Anastomosis
(6 marks)
a) Antagonist - muscles that oppose the prime movers
b) Ganglion - a cystic swelling resulting from mucoid degeneration of synovial sheath around
tendons/ collection of cell bodies of neurons in the peripheral nervous system
c) Bursa – synovial fluid filled bag in relation to joints and bones to prevent friction

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d) Epiphysis – the end and tips of a bone which ossify from secondary centres
e) Sesamoid bones – bony nodules found embedded in tendons or joint capsules. They have
no periostium and ossify after birth
f) Anastomosis – precapillary or postcapillary communication between the neighbouring
vessels

13. In one of the severe road accidents, a college boy was found to have an unstable
right knee joint. On examination under anesthesia, the surgeon was able to pull the
tibia forward excessively on the femur. The surgeon diagnosed an injury to one of
the ligaments of the knee.
a. Name the ligament injured in this case?
b. Give the attachments and functions of that ligament.
(1+2=3 marks)
a) Anterior cruciate ligament

b) Attachments:
Lower attachment: anterior part of intercondylar area of tibia
Upper attachment: posterior part of medial surface of lateral condyle of femur
Function: acts as direct bond of union between tibia and femur. Maintains anteroposterior
stability of knee joint

14. Following a major operation, a patient was given a course of antibiotics; the nurse
was instructed to give injections by intramuscular route in the buttock region.
Following this the patient started experiencing numbness and tingling sensation on
the anterior and lateral side of right leg and dorsum of foot. He also said that his
right foot tended to catch on steps. On examination there was loss of sensation of
skin on the anterior and lateral sides of right leg and dorsum of right foot and also
the foot was plantar flexed. Immediately the surgeon realized that the
intramuscular injections were given on wrong sites of buttock.

a. What is the right site of intramuscular injection in the buttock and why?
b. Using your anatomy knowledge explain the reasons for symptoms shown by the
patient after wrongly placed intramuscular injections.

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 (½+1+1½=3 marks)
a) Anterosuperior part of gluteal region

b) The peroneal component of sciatic nerve is injured:

 the anterior compartment of leg is supplied by deep peroneal nerve while leteral
compartment is supplied by superficial peroneal nerve, both nerves are branches of
common peroneal nerve which arises from sciatic nerve
 there is loss of dorsiflexion of foot due to paralysis of muscles of anterior
compartment of leg that are supplied by deep peroneal nerve
 lateral cutaneous nerve of calf is branch of common peroneal nerve and it supplies
skin of upper 2/3 of lateral part of leg
 superficial peroneal nerve supplies lower 1/3 of skin of lateral part of leg and skin
over dorsum part of leg

15. Name the muscles attached to the upper end of medial surface of tibia. Mention
origin, nerve supply and actions of one of them.
(3 marks)
Muscles: Sartorius, gracilis, semitendinosus

Sartorius:
Origin: anterior superior iliac spine
Nerve supply: anterior division of femoral nerve
Actions: Abduction and lateral rotation of thigh. Flexion of leg at knee joint

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16. A group of students went for rock-climbing. One of them lost his foot on the edge
of crevasse as he was climbing up. As he started to fall, he grabbed at a bush with
his outstretched right hand. His companions immediately came to his help and
brought him to the hospital. There, he was examined by a physician and was
found to have damaged the first thoracic spinal nerve. He also observed that his
right hand fingers were flexed at interphalangeal joints and extended at
metacarpophalangeal joints. Using your anatomy knowledge answer the following
questions.

a. How does the first thoracic spinal nerve contribute for brachial plexus?
b. Why were the fingers flexed at interphalangeal joints and extended at
metacarpophalangeal joints? What is that condition called?
(1+1+1=3 marks)
a) It joins with anterior primary rami of C8 to form the lower trunk of brachial plexus

b) T1 spinal nerve fibres supply the intrinsic muscles of the hand. Lumbricals of the hand
flex the metacarpophalangeal joint and extend the interphalangeal joints. When they are
paralysed, we get the above condition.
Condition : Claw hand

17. Name the vessel which is used for taking the pulse at the wrist. Mention its origin,
course, termination and branches.
(½+4=4½ marks)
Radial artery
 Origin: terminal branch of brachial artery at cubital fossa at level of neck of
radius

 Course : -runs downwards to the wrist with lateral convexity

-It leaves forearm by turning posteriorly and enters anatomical
snuffbox to reach proximal part of 1st interosseous space
-then it passes between the 2 heads of 1st dorsal interosseous muscle
and 2 heads of adductor pollicis

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  Termination : ends by forming the deep palmar arch in the palm

 Branches : in forearm –medial recurrent artery

Muscular
Palmar carpal branch
Superficial palmar branch
In dorsum of hand –first dorsal metacarpal artery
In palm –princeps pollicis artery
Radialis indicis

18. Mention the muscles attached to the scapula with the help of diagrams.
(4 marks)
Anterior view:

Muscles:
Deltoid
Trapezius
Pectoralis minor
Biceps brachii
Serratus anterior
Subscapularis
Triceps brachii

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Posterior view:

Muscles:
Supraspinatus
Infraspinatus
Trapezius
Deltoid
Levator scapulae
Rhomboid major
Rhomboid minor
Lattisimus dorsi
Teres major
Teres minor
Triceps brachii

19. What are the muscles of the front of the arm? Mention the origin, insertion, action
and nerve supply of any one of them.
(3½ marks)
Muscles: caracobrachialis, biceps brachii, brachialis

Coracobrachialis:
 Origin : tip of corocoid process
 Insertion : middle of medial border of humerus
 Action : flexes arm at shoulder joint
 Nerve supply : musculocutaneous nerve

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20. Write short notes on
a. Zona pellucida
b. Corpus luteum
c. Decidua
(2+2+2=6 marks)
a) zona pellucida:
 A type of glycoprotein that separates oocyte from granulosa cells
 When a sperm touches, the zona induce acrosome reaction and changes
its property and becomes impermeable to other sperms
 After fertilization it prevents blastocyst from attaching to sites other than
the uterus hence prevents ectopic pregnancy
 It disappears on the 6th day of fertilisation when blastocyst reaches the
fundus of uterus

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b) Corpus luteum:

 During ovulation, the granulosa cells surrounding the oocyte are expelled from
the overy
 The remaining granulosa cells and theca interna become vascularised and form
corpus luteum
 Under the influence of leutinizing lormone(LH) the cells develope a yellowish
pigment called lutin
 It secretes estrogen and progesterone which prepares endometrium for
implantation
 If fertilization occur, it helps maintain pregnancy for first 4 months after which
placenta takes over
 If fertilization does not occur, it degenerates to form corpus albicans

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c) Decidua:

 It is the endometrium of pregnancy, area where the blastocyst is implanted

 Is thick and oedematous
 Has uterine glands that are thick, tortuous and secrete uterine milk to nourish early
embryo
 After implantation it divides into :
1. Decidua basalis- part lying deep to implanted blastocyst
2. Decidua capsularis- part between blastocyst and uterine cavity
3. Decidua parietalis (decidua vera)- rest of endometrium
 During late pregnancy, decidua capsularis and parietalis fuse with each other
 Decidua basalis forms maternal part of placenta
 Uterine endometrium during pregnancy is called decidua because it is shed during
child birth

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21. Describe the changes taking place in the trophoblast during the second week of
development
(4 marks)

 Tropoblast divides into 2 layers

 Outer layer is syncytiotropoblast and inner layer is cytotropoblast
 Syncytiotropoblast- cell boundaries are not well defined and looks like single
multinucleated mass
 Cytotropoblast- single layer of cells deep to syncytiotropobast
 During 2nd week, spaces called lacunae appear in syncytiotropoblast and
syncytiotropoblast forms finger shaped projection into which cells of cytotropoblast
extend
 The finger shaped extensions are called villi and in early stages the villi arefound all
over blastocyst but later only the embryonic pole retains the villi and are called
chorion frondosum while other parts which are smooth are called chorion laevae
 Villi erode the uterine endometrium and endometrium vessels

22. What type of cartilage covers the articular surfaces of the shoulder joint? Describe
its microscopic structure with the help of a diagram.
(1+4=5 marks)
Hyaline cartilage

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 Hyaline cartilage is covered by perichondrium
 Perichondrium has outer fibrous layer (fibrogenic layer) and inner cellular layer
(chondrogenic layer)
 Fibrous layer is made up of collagen fibres and cellular layer contains chondroblasts
 Hyaline cartilage has a basophilic matrix

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  The matrix is classified as territorial matrix and interterritoreal martrix
 Matrix contains lacune
 The lacunae contain chondrocytes
 The chondrocytes are in groups called cell nests
 The cell nests surrounded by darkly staining territorial matrix

23. Describe the structure of hyaline cartilage with the help of a neat labeled diagram.
(4½ marks)
SAME AS ABOVE Q22

24. Describe the structure of a typical synovial joint. Illustrate your answer with a
simple diagram.
(4 marks)

Synovial joint:
 A typical synovial joint contains two articular surfaces
 The articular surfaces are covered by hyaline cartilage which is called articular
cartilage
 The joint has a cavity called joint cavity
 This cavity contains a small amount of synovial fluid
 Synovial fluid is produced by the synovial membrane that lines the cavity except for
the actual articular surface.
 The fluid act as a lubricant
 The joint cavity is covered by a capsular ligament
 In some joints, out side the capsule, there will be extracapsular ligaments

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25. Briefly explain the formation, function and fate of the secondary yolk sac.
(4 marks)
Secondary yolk sac/Definitive yolk sac:

The yolk sac is a derivative of hypoblast cells of the embryonic disc. In the second week of
intrauterine life, the cells of the hypoblast line the blastocyst cavity as they form a membrane
called Heuser's membrane or exocelomic membrane. The new cavity formed is called
exocelomic cavity or primitive yolk sac.
The primitive yolk sac becomes smaller as the extraembryonic mesoderm and coelom
develop. After the formation of extraembryonic coelom the yolk sac is called secondary yolk
sac.
Later, during the folding of the embryo the yolk sac is incorporated into the body of the
embryo. The part of yolk sac that is incorporated into the body of the embryo will form the
lining epithelium of the GIT.
Functions: The yolk sac serves a nutritive role till the placenta is formed. It is the site of
development of blood cells and primordial germ cells. Its role in formation of GIT has
already been discussed.

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Fate: The yolk sac detaches from the gut in second half of gestation and degenerates. The
detached and degenerating yolk sac can be seen in the umbilical cord for some time of
intrauterine life.

26. Briefly describe the three phases of the uterine cycle.

(4½ marks)

 Menstrual phase:-bleeding or hemorrhagic phase

-superficial 2/3 of endometrium is shed off
-these parts of endometrium are shed of by ruptured endometrial
Arteries

 Proliferative phase: - re-epithelialisation of endometrium

-remaining basal portions of uterine glands proliferate to reform

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 the epithelium of endometrium
-endometrium thickens
-uterine glands elongate
-ovulation occurs during this stage on 14th day
-after ovulation corpus luteum form and secretes progesterone
-progestrone cause endometrium to enter secretory phase

 Secretory phase: -depends on progesterone and estrogen secreted by corpus luteum

-endometrium walls become thicker and have 3 layers
(deep stratum basale. middle sratum spongiosum, superficial
stratum compactum)
-uterine arteries become large and tortuous and are called spiral
arteries
-uterine glands are further elongated and tortuous and start secreting
fluid to nourish the embryo
-if fertilisation does not occur,then corpus luteim degenerates and
forms corpus albicans
-this decreases progesterone and estrogen secretion and result in
shedding of endometrium wall

27. Describe the formation and fate of the notochord.

( 3 marks )
Please refer to the previous answers

28. Mention the extent and branches of the brachial artery. Add a note on its relations.
(1+1½+2½=5 marks)
 Extent : from the lower border of teres major muscle to a point in front of the elbowat
the level of the neck of radius
 Branches : muscular
Profunda brachii artery
Superior ulnar collateral artery
Nutrient artery
Inferior ulnar collateral artery

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 Radial artery
Ulnar artery
 Relations :
1. Anteriorly: crossed by median nerve from lateral to medial side
Bicipital aponeurosis
Median cubital vein
2. Posteriorly :triceps brachii
Radial nerve and profunda brachii artery
3. Medially :upper part- ulnar nerve and basilic vein
Lower part- median nerve
4. Laterally : upper pert- coracobrachialis,biceps brachii, median nerve
Lower part- tendon of biceps brachii at elbow

29. Name any six muscles attached to the scapula. Give their nerve supply.
(3 marks)

MUSCLES NERVE SUPPLY

Supraspinatus Suprascapular nerve
Infraspinatus Suprascapular nerve
Teres minor Axillary nerve
Subscapularis Upper and lower
subscapular nerves
Teres major Lower subscapular
Lattisimus dorsi Thoracodorsal nerve

30. Mention the boundaries and contents of the cubital fossa.

(3 marks)
Boundaries:
 Laterally : medial border of the brachioradialis
 Medially : lateral border of pronator teres
 Base : directed upwards and represented by an imaginary line joining the front of two
epicondyles of humerus
 Apex : directed downwards and is formed by meeting point of lateral and medial
boundaries

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Contents: (from lateral to medial side)
 Median nerve
 Termination of brachial artery, radial and ulnar arteries
 Tendon of biceps brachii

31. Following a severe automobile accident, a 28-year-old man was found to have an
unstable knee joint. On examination under an anesthetic, it was possible to pull the
tibia forward excessively on the femur.
a. What structure was damaged in the knee joint? Give its attachments.
b. Mention the muscles producing flexion and extension of the knee joint.
(2+2=4 marks)
a) Anterior cruciate ligament
Attachments: As in question 13

b) Flexion of the knee:

 Biceps femoris
 Semitendinosus
 Semimebranosus
Extension of the knee:
 Quadriceps femoris-rectus femoris,vastus medialis, vastus lateralis, vastus
Intermedius

Durga & Sathis

32. Explain the origin, course and termination of the femoral artery. Name its
branches.
(1+1+1+1=4 marks)
Femoral artery:
 Origin : continuation of external iliac artery behind inguinal ligament at
Midinguinal point

 Course : -passes downwards and medially, first in femoral triangle then in

adductor canal
-at lower end of adductor canal, it passes through an opening in adductor
magnus

 Termination : continues as popliteal artery after coming out of opening at adductor

magnus
Branches:
 Superficial external pudendal
 Superficial epigastric
 Superficial circumflex iliac
 Profunda femoris
 Deep external pudendal
 Muscular
 Descending genicular

33. Explain the origin, course and termination of the great saphenous vein. Mention its
tributaries.
(1+1+1+1=4 marks)
Great saphenous vein:
 Origin : at dorsum of foot by union of medial end of dorsal venous arch and medial
marginal vein

 Course : -ascends in front of medial malleolus

-At lower 1/3 of leg, pass obliquely across medial surface of tibia
-in upper 2/3 of leg ascends along medial border of tibia to posteromedial
Side of knee

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 -it is accompanied by saphenous nerve
-in thigh it inclines forwar to reach saphenous opening

 Terminatiom : drains into femoral vein

Tributaries:
 Medial marginal vein
 Anterior vein of leg
 Posterior arch vein
 Accessory saphenous vein
 Anterior cutaneous vein of thigh
 Superficial epigastric, superficial circumflex iliac, superficial external pudendal
 Deep external pudendal

34. Give the origin and insertion of gluteus maximus. Mention any four structures
under cover of the same.
(1+1+1=3 marks)
Gluteus maximus:
 Origin : posterior gluteal line
Outer slope of dorsal segment of iliac crest
 Insertion : gluteal tuberocity
Iliotibial tract

Structures passing undercover:

 Gluteus medius
 Gluteus minimus
 Piriformis
 Obturator internus with 2 gamelli

Durga & Sathis

35. Write a note on:
a. The synovial membrane of the knee joint.
b. Locking and unlocking movements of the knee
(2+3=5 marks)
a) Synovial membrane of knee joint:
 Lines the capsule except posteriorly where it is reflected forwards by cruciate
ligaments, forming common coverings of both ligaments
 In front, it is absent from patella
 Above patella it is prolonged forwards as suprapatellar bursa
 Below patella, it covers deep surface of infrapatellar pad of fat which separates it
from ligamentum patellae
 A median fold,infrapatellar synovial fold extends backward from pad of fat to
intercondylar fossa of femur
 An alar fold diverges on each side of median fold to reach lateral edge of patella

b) Refer question No. 6

36. A patient brought to the orthopedic department exhibited a positive

Trendelenburg’s sign.
a. What is a positive Trendelenburg’s sign?
b. Mention three main conditions where Trendelenburg’s sign is positive
c. Explain the attachments and innervation of the muscles probably involved in
this case
(1+1½+2½=5 marks)
a) It is the dropping of the unsupported side of pelvis due to defective abductor mechanism

b) Condition:
 Paralysis of gluteus medius and minimus
 Congenital or pathological dislocation of hip
 Ununited fracture of neck of femur

c) Gluteus medius:
 Origin :gluteal surface of ilium between anterior and posterior gluteal line
 Insertion : greater trochanter of femur on oblique ridge on lateral surface

Durga & Sathis

 Gluteus minimus:
 Origin : Gluteal surface of ilium between anterior and inferior gluteal lines
 Insertion : greater trochanter of femur on ridge on lateral side of anterior surface

Innervations: superior gluteal nerve

37. A patient visited the physician with elongated, tortuous veins in both his lower
limbs. The upper limb veins were normal.
a. What are such long, tortuous veins in the lower limb known as?
b. What are the various causes for this condition?
c. Explain the factors helping the venous drainage in the lower limb
(1+2+2=5 marks)
a) Varicose veins

b) Cause:
 Valves in perforating veins or at termination of superficial vein becomes incompetent
causing high pressure of deep veins to be transmitted to superficial veins
 Compression of iliac vein due to enlarges uterus in pregnancy

c) Factors:
 Negative intrathoracic pressure during inspiration
 Arterial pressure and overflow from capillary bed
 Presence of valves
 Muscular contraction in active limb compress deep veins and drive blood upwards

38. Describe the monthly changes occurring in the uterine endometrium of a healthy
female who has attained menarche but has not reached menopause.
(5 marks)

Please refer to question 26.

Durga & Sathis

39. A lady visited the gynecologist with a complaint of per vaginal bleeding in the
second part of pregnancy. After examining her, the doctor explained to her that it
was a case of placenta previa and was due to the abnormal implantation of the
blastocyst.
a. What is placenta previa?
b. What are the normal and abnormal sites of implantation?
c. Write a note on the process of implantation of the blastocyst
(1+2+2=5 marks)
a) Placenta previa is a condition when placenta is attached to the lower uterine segment

b) Normal:
 posterior wall of fundus of uterus
 anterior and posterior walls of body of uterus

Abnormal:
 ovary
 rectouterine pouch
 uterine tube
 vagina

c) Implantation of blastocyst:
 begins at the end of 1st week and is completed in 2nd week
 the 1st event is the disappearance of zona pellucida (zp)

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  zp prevents blastocyst from getting implanted in abnormal site
 after zp is removed, blastocyst adheres to endometrium
 the cells of blastocyst digest endometrium and make a hole in it which allows the
blastocyst to go deeper into endometrium
 then the endometrium grows over and covers it

40. a. Write short notes on synovial joints.

b. Classify them with examples.
c. Mention any two factors which maintain the stability of the joint.
(2+2+1=5 marks)
For a and b PLEASE REFER TO THE PREVIOUS QUESTIONS
c) Factors maintaining stability of joint:
 Tone of different group of muscles acting on the joint
 Ligaments and bones

Durga & Sathis

41. A 17 year old boy who had a fracture of the foot was advised to use crutches for a
period of time. Later he complained about difficulty in extending the elbow and
wrist joints and loss of skin sensations on the lower part of posterior surface of arm
and forearm which extended on to the dorsum of hand.
a. What is your diagnosis?
b. Mention the nerve involved and the site of injury.
c. Name the branches of the nerve which is affected.
(1+2+2=5 marks)
a) “Crutch paralysis” of rdial nerve causing “wrist drop”

b) Radial nerve at spiral groove

c) Branches of nerve which is affected:

 Deep terminal branch (posterior interosseous nerve)
 Superficial terminal branch
 Lower lateral cutaneous nerve of the arm
 Posterior cutaneous nerve of the arm
 Posterior cutaneous nerve of forearm
 Muscular branches to three heads of triceps, anconeus, brachialis, brachioradialis and
extensor carpi radialis longus muscles
 Articular branch to elbow joint

42. Describe the microscopic anatomy of transverse section of compact bone with a
neat labeled diagram.
(5 marks)
Please refer the previous answers

43. Explain the shoulder joint under the following headings:

a. Type
b. Ligaments
c. Movements and muscles producing them.
(1+2+2=5 marks)

Durga & Sathis

a) Synovial joint (ball and socket)

b) Ligaments:
 Capsular ligament
 Coracohumeral ligament
 Transverse humeral ligament
 Glenoidal labrum
 Glenohumeral ligament

c) Movement and muscle:

 Flexion: clavicular head of pectoralis major
Anterior fibres of deltoid
 Extension: posterior fibres of deltoid
Latissimus dorsi
 Adduction: pectoralis major
Latissimus dorsi
Short head of biceps brachii
Long head of triceps brachii
 Abduction: supraspinatus
Deltoid
Serratus anterior
Upper and lower fibres of trapezius
 Medial rotation: pectoralis major
Anterior fibres of deltoid
Latissimus dorsi
Teres major
 Lateral rotation : posterior fibres of deltoid
Infraspinatus
Teres minor
 Circumduction: sequential contraction of above muscles

Durga & Sathis

44. A 35 year old man, walking by the side of the stream accidentally slipped and fell
into the water. He was caught in the stream of running water and in his attempt to
escape caught a fence on the side. A rusty nail punctured the palm in front of the
fourth metacarpal bone. Two days later, the wound became infected, painful and
the inner half of the palm became swollen.
a. What is your diagnosis?
b. Explain the boundaries of the space infected with a labeled diagram.
c. If left untreated, where is the infection likely to spread?
d. How can you drain the infection?
(1+2+1+1=5 marks)
a) Infection of mid palmar space

b) Boundaries:
 Anterior: flexor tendon of 3rd , 4th , and 5th finger
2nd, 3rd and 4th lumbricals
Palmar aponeurosis
 Posterior: fascia covering interossei and metacarpal
 Lateral : intermediate palmar septum
 Medial : medial palmar septum

c) Forearm space

d) Drainage: incision in either 3rd or 4th web space

Durga & Sathis

45. A 45 year old woman was admitted to the hospital with a dislocation of the right
shoulder joint. A senior medical student carefully examined the arm for
neurological defects. He asked the patient to try and abduct the shoulder joint. But
she could not. With your knowledge of anatomy answer the following questions.
a. Why was the patient unable to abduct her right arm?
b. Which nerve was injured after dislocation?
c. Give the course and distribution (both motor and sensory) of the nerve injured.
(1+1+3=5 marks)
a) Because the deltoid muscle is paralysed

b) Axillary nerve

c) Axillary nerve
 Course : passes through lower part of axilla into quadrangular spaceand terminates
into anterior and posterior branches

 Distribution :
-Anterior division supplies deltoid and skin over its anteroinferior part
-posterior branch supplies teres minor and posterior part of deltoid
-posterior branch continues as upper lateral cutaneous nerve of arm which
supplies skin covering lower half of deltoid

Durga & Sathis

46. A 58 year old woman with extensive osteo arthritis of the right hip joint is about to
undergo surgery for total hip joint replacement with a prosthesis. As the attending
physician you have the responsibility of fully explaining the function of the
prosthesis. It should be noted that the artificial joint is of the same type as that of
hip.
a. To what type does the hip joint belong?
b. Describe the adduction of hip joint.
c. Name the three gluteal muscles and state their actions.
d. Which member of the quadriceps femoris muscle acts both the hip and the
knee joints?
(½+1+3+½=5 marks)

a) Synovial type

b) Adduction of hip joint:

 Muscles: adductor longus, brevis and magnus (cheif)
Pectineus and gracilis (accessory)
 It is limited by contact with the opposite limb

c) Gluteal muscles:
 Gluteus maximus: cheif extensor of thigh at hip joint
 Gluteus medius and minimus:- abductor of thigh, medial rotators
-maintain balance of body when opposite foot is off the
Ground
d) Rectus femoris

Durga & Sathis

47. A medical student, while playing foot ball, collided with another player and fell to
the ground. As he fell, the right knee was partially flexed, femur was rotated
medially and the leg was abducted on the thigh. A sudden pain was felt in the right
knee joint and he was unable to extend it, which was by now greatly swollen.
Severe local tenderness was felt along the medial side of the joint.
a. What is your diagnosis?
b. Explain the structure which is injured and give its functions.
c. Why was the swelling of the knee so extensive at the front of the joint?
(1+3+1=5 marks)
a) Injury of the right medial meniscus

b) Medial meniscus –fibrocartilagenous disc

-nearly semicircular
-its wider behind than in front
-posterior fibres of anterior end are continuous with transverse ligament
-its peripheral margin is adherent to deep part of tibial collateral ligament
Functions:
 Help make articular surface more congruent
 Serve as shock absorbers
 Help lubricate joint cavity
 Have sensory function due to their nerve supply

c) The knee joint capsule is very weak. This allows swelling of the knee. In addition to this,
the synovial membrane of the knee extends up as the supra patellar bursa. This will also make
the knee swell in trauma of the knee

48. Classify the bones according to their shape. Name the parts of an immature long
bone. Write briefly about the blood supply of a long bone.
(1½+1½+2=5 marks)

CLASS OF BONES EXAMPLE

Long bones Humerus
Short bones Tarsal bones
Short long bones Metacarpals and metatarsals

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 Flat bones Sternum , scapula
Irregular bones Hip bone
Pneumatic bone Maxilla , sphenoid
Sesamoid bone Patella, pisiform bone
Accessory (supernumery) Sutural bones
bone
Heterotopic bones Rider’ bones - bone in adductor
magnus

Parts of immature long bone:

 Epiphysis
 Epiphyseal plate
 Metaphysis
 Diaphysis

Blood supply of long bones:

 Nutrient artery:- enters shaft through nutrient foramen and divides into ascending and
descending branch in medullary cavity
-supply medullary cavity, inner 2/3 of cortex and metaphysic
 Periosteal artery: -numerous beneath muscular and ligament attachments
-ramify beneath periosteum and enter Volkmann’s canal to supply
Outer 1/3 of the cortex
 Epiphysial artery: -derived from periarticular vascular arcades(circulus vasculosus)
Found on the nonarticular bony surfaces
 Metaphysical artery: -derived from neighbouring systemic vessels
-pass directly into metaphysisand reinforce metaphysial
Branches from primary nutrient artery

49. Write the formation, course, termination and tributaries of great saphenous vein.
(½+1+½+3=5 marks)
Great saphenous vein:
 formation :at dorsum of foot by union of medial end of dorsal venous arch and medial
marginal vein

Durga & Sathis

  Course : -ascends in front of medial malleolus
-At lower 1/3 of leg, pass obliquely across medial surface of tibia
-in upper 2/3 of leg ascends along medial border of tibia to posteromedial
Side of knee
-it is accompanied by saphenous nerve
-in thigh it inclines forward to reach saphenous opening

 Terminatiom : drains into femoral vein

Tributaries :
 Medial marginal vein
 Anterior vein of leg
 Posterior arch vein
 Accessory saphenous vein
 Anterior cutaneous vein of thigh
 Superficial epigastric, superficial circumflex iliac, superficial external pudendal
 Deep external pudendal

50. Write the commencement, course, termination and branches of the radial artery.
(½+1+½+3=5 marks)
Radial artery
 Origin: terminal branch of brachial artery at cubital fossa at level of neck of
radius

 Course : -runs downwards to the wrist with lateral convexity

-It leaves forearm by turning posteriorly and enters anatomical
Snuffbox to reach proximal part of 1st interosseous space
-then it passes between the 2 heads of 1st dorsal interosseous muscle
2 heads ofadductor pollicis

 Termination : ends by forming the deep palmar arch in the palm

 Branches : in forearm – Radial recurrent artery

Muscular
Palmar carpal branch

Durga & Sathis

 Superficial palmar branch
In dorsum of hand –first dorsal metacarpal artery
In palm –princeps pollicis artery
Radialis indicis

51. Explain supination. Give the attachments and nerve supply of the muscles
producing this movement.
(1+4=5 marks)
Supination: when the palm is facing forwards or upwards, as in putting food in the mouth

Muscle: Biceps brachii

 Origin : short head-tip of corocoid process of scapula
Long head-supraglenoid tubercle of scapula
 Insertion : posterior rough part of radial tuberosity
 Nerve supply : musculocutaneous nerve

Supinator:
 Origin : lateral epicondyle of humerus
 Insertion : neck and shaft of upper 1/3 of radius
 Nerve supply : deep branch of radial nerve

52. Write in detail about the structure of a sperm with the help of a neatly labeled
diagram.
(5 marks)

Durga & Sathis

Structure of a sperm:
A sperm has a head (caput), neck (cervix), and a tail (cauda) which is divided into middle
piece, principle piece, and an end piece.
 Head : -consist of a large nucleus with homogenous chromatin and has no cytoplasm
-its terminal 2/3 is covered by a laminar acrosomal cap
-acrosome has acid phosphatise, protease and hyaluronidase enzyme needed
-penetrationof oocyte during fertilization
-nucleus and acrosome is covered by plasma membrane without intervening
cytoplasm
 Neck : -constricted part between head and middle piece
-at base of nucleus there is proximal centriole
-has small amount of cytoplasm
 Middle piece: -contains axial bundles or microtubules
-surrounded by mitochondrial sheath which has mitochondria in it
-axial bundle is made of a central pair of filaments surrounded by 9
pair of peripheral filaments and outer to this there are 9 coarser fibrils
-at caudal end there is an annulus (distal centriole)
 Principle piece : -motile part of sperm
-its terminal part is called tail piece and resembles a flagellum

Durga & Sathis

53. Discuss the umbilical cord under the following headings:
a. Formation
b. Contents
c. Applied aspects
(3+1+1= 5 marks)
Umbilical cord:
 Formation :

-is derived from connecting stalk

-connecting stalk is made up of extraembryonic mesoderm
-as the embryo folds, the connecting stalk gets a covering of amnion after which it is
called umbilical cord

Durga & Sathis

 -It will lengthen and become as long as foetus (about 50 cm) at birth
-As the foetus rotates during foetal life, the umbilical cord forms false knots

 Contents :

-Wharton’s jelly
-2 umbilical arteries
-1 umbilical vein
 Applied aspects:
-abnormal movements can cause winding of umbilical cord around some part of
embryo and lead to under development of those parts

54. Discuss the root value, course and distribution of femoral nerve.
(5 marks)
 Root value : dorsal division of anterior primary rami of spinal nerve L2,L3,L4
 Course :
-enters femoral triangle by passing behind inguinal ligament lateral to femoral artery
-in thigh, lies in groove between iliacus and psoas major outside femoral sheath and
lateral to femoral artery
- it terminates into anterior and posterior division which is separated by lateral
circumflex femoral artery
 Distribution :
-muscular: ant division- supplies sartorius
Post division- supplies rectus femoris, 3 vasti and articularis genu

Durga & Sathis

 -Cutaneous -anterior division: intermediate and medial cutaneous nerve of thigh
Posterior division: saphenous nerve
- Articular - hip joint by nerve to rectus femoris
knee joint by nerve to 3 vasti
- Vascular – to femoral artery

55. Draw a diagram of the transverse section of a compact bone and explain its
histological structure.
(5 marks)
Please refer the previous answers

56. Write the origin, insertion, action and nerve supply of triceps surae.
(2+1+1+1 = 5 marks)
Triceps surae:
 Gastrocnemius
Origin:
Medial head: medial condyle of femur behind adductor tubercle
Lateral head: upper posterolateral surface of lateral condyle of femur
Insertion: via calcaneal tendon to posterior surface of calcaneus
 Soleus
Origin:
Back of the head and upper ¼ of shaft of fibula
Soleal line and meddle 1/3 of medial border of shaft of tibia
Soleal arch
Insertion: SAME AS gastrocnemius
 Nerve supply : tibial nerve
 Action : plantar flexes the foot

Durga & Sathis

57. A 55 year old woman complaining of a dull, aching pain in the lower part of both
legs visited her physician. She stated that the pain was particularly severe at the
end of a long day of standing at her work, on examination, the skin showed
discoloration over the medial malleoli, was dry and scaly and the veins were very
much enlarged.

a. What is this condition called and explain how it occurs.

b. Describe the origin, course and termination of the superficial veins of the lower
limbs.
(2+3=5 marks)
a) Varicose veins
 When venous valve become incompetent, they exert extra pressureon distal valves
and cause them to become incompetent too
 This produces dilated tortuous superficial veins known as varicose veins
 Formation of varicose veins is commonly seen in people who stand for long
durations (Ex: waiters, traffic police etc)
b) Superficial veins
Great saphenous vein:
 formation :at dorsum of foot by union of medial end of dorsal venous arch and
medial marginal vein
 Course : -ascends in front of medial malleolus
-At lower 1/3 of leg, passes obliquely across medial surface of tibia
-in upper 2/3 of leg ascends along medial border of tibia to posteromedial
Side of knee
-it is accompanied by saphenous nerve
-in thigh it inclines forward to reach saphenous opening

 Terminatiom : drains into femoral vein

Small saphenous vein:

 Origin : at dorsum of foot by union of lateral end of dorsal venous arch with lateral
marginal vein
 Course :
-enters back of leg by passing behind lateral malleolus

Durga & Sathis

 -in leg it ascends lateral to tendocalcaneous and then along middle line of calf to
lower part of popliteal fossa and pierces the deep fascia

 Termination : opens into popliteal vein

58. Ronaldo a medical student, while playing foot ball collided with another player. He
was hit on the lateral side of the extended knee. On examination, it was possible to
pull the tibia excessively forward on the femur; there was pain on medial rotation
of the tibia on the femur.

a. Name the clinical condition and structures involved.

b. Give their attachments.
c. Explain locking and unlocking movements of the joint and name the muscles
producing them.
(2+3+3=8 marks)

a) Derangement of intra-articular structures of the knee. It is also called “unhappy

triad” “terrible triad” or a “blown knee”. Structures involved in this injury are
anterior cruciate ligament, medial meniscus and medial collateral ligament of the knee

b) Anterior cruciate ligament

Attachments:
Lower attachment: anterior part of intercondylar area of tibia
Upper attachment: posterior part of medial surface of lateral condyle of femur
Function: acts as direct bond of union between tibia and femur. Maintains anteroposterior
stability of knee joint
Medial meniscus –fibrocartilagenous disc
-nearly semicircular
-its wider behind than in front
-posterior fibres of anterior end are continuous with transverse ligament
-its peripheral margin is adherent to deep part of tibial collateral ligament
Functions:
 Help make articular surface more congruent

Durga & Sathis

  Serve as shock absorbers
 Help lubricate joint cavity
 Have sensory function due to their nerve supply
Medial collateral ligament (tibial collateral ligament):
Superior attachement: to the medial epicondyle of femur just below the adductor tubercle
Inferior attachement: divides into anterior and posterior parts
Anterior part is attached to medial boder and medial surface of shaft of the tibia
Posterior part is attached to the medial condyle of tibia above the groove for
semimembranosus. It blends with the medial meniscus
It maintains side to side stability of the joint

c) For locking and unlocking, please refer the previous answers

59. A 64 – year old woman fell down the stairs and was admitted to the emergency
department with severe left shoulder pain. A diagnosis of subcoracoid dislocation
of the left shoulder joint was made. The physician then systematically tested the
cutaneous sensibility of the left upper limb and found severe sensory deficits
involving the skin of the back of the arm down as far as the elbow, the lower lateral
surface of the arm down to the elbow, the middle of the posterior surface of the
forearm as far as the wrist, the lateral half of the dorsal surface of the hand, and
the dorsal surface of the lateral three and one – half fingers proximal to the nail
beds.

a. Name the structure involved.

b. Give its root value, course, branches and motor distribution.
(1+5=6 marks)
a) Radial nerve

b) Root value: anterior primary rami of spinal nerves C5-C8, T1

Course:
 It is given off in lower part of axilla from the posterior cord of brachial plexus
 Runs behind 3rd part of axillary artery
 In arm it lies behind brachial artery

Durga & Sathis

  Leaves brachial artery to enter lower triangular space to reach the oblique radial
su;cus on the back of humerus
 It reaches lateral side of arm and pierces the lateral intermuscular septum to enter
anterior compartment of arm on its lateral aspect
 Descends down across lateral epicondyle into cubital fossa
 Terminates by dividing into superficial and deep branch at level of lateral epicondyle

Branches:
 Muscular branches (refer previous answers)
 Posterior cutaneous nerve of arm
 Lateral cutaneous nerve of arm
 Posterior cutaneous nerve of forearm
Motor distribution:
 Before entering spiral groove-supplies long and medial heads of triceps brachii
 In spiral groove- supplies lateral and medial head of triceps brachii and anconeus
 Below radial groove-supplies brachialis, brachioradialis and extensor carpi radialis
longus

60. How is femoral sheath formed? What is femoral hernia?

(2 marks)
Femoral sheath:
 The downward extensionof 2 layers of fascia of the abdomen
 Anterior wall is formed by fascia transversalis
 Posterior wall is formed by fascia iliaca

Durga & Sathis

 Femoral hernia:
 Protrusion of the contents of abdomen through the femoral canal

61. Write short notes:

a. List the parts of intraembryonic mesoderm and their fate.
b. Initiation and formation of the neural tube.
(5x2=10 marks)
a)
PARTS FATE
Paraxial mesoderm  Gives rise to somites
 Each somite has three parts: dermatome, myotome
and sclerotome
 Dermatome forms the dermis of the skin
 Myotome forms the skeletal muscles
 Sclerotome forms the vertebrae and annulus
fibrosus of intervertebral disc
Intermediate  It forms nephrogenic cord
mesoderm  Nephrogenic cord forms pronephros, mesonephros
and metanephros
 The above structures differentiate into urogenital
structures
Lateral plate  Divides into parietal layer and visceral layer
mesoderm  Parietal layer forms body wall and limbs, bones and
connective tissues of limbs and sternum
 Visceral layer forms wall of gut tube

b) Neural tube:
1. Initiation :
 It is induced by the underlying notochord
2. Formation :
 Ectoderm overlying notochord thickens to form neural plate by the
process of neurulation and the cells of the plate are called
neurectoderm
 Lateral edges of neural plate form folds called neural fold

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 Depression between the folds a called neural groove
 Gradually the folds approach each other and meet at midline
 Fusion begins at cervical region and proceeds cranially and caudally
 The fusion of neural folds form neural tube which at the beginning has
2 opening at its 2 ends
 Cranial opening is called cranial neuropore and caudal opening is
called caudal neuropore
 Cranial neuropore closes on 25th day and caudal neuropore closes at
27th day
 Neural tube differentiats into brain and spinal cord

Durga & Sathis

62. Explain axillary artery under the following headings:
a. Extent
b. Relations
c. Branches
(1+2+2=5 marks)
st
a) Extent: from outer border of the 1 rib to the lower border of teres major

b) Relation:
 1st part
-laterally: lateral cord and posterior cord
-posteriorly: medial cord
 2nd part
-laterally: lateral cord
-medially: medial cord
-posteriorly: posterior cord
 3rd part
-laterally: musculocutaneous nerve (upper part), median nerve (lower part)
-medially: medial cutaneous nerve of forearm, ulnar nerve, axillary vein, medial
cutaneous nerve of arm
-posteriorly: axillary nerve (upper part) , radial nerve (lower part)

c) Branches:
 1st part: superior thoracic artery
 2nd part: thoracoacromial artery , lateral thoracic artery
 3rd part: subscapular artery, anterior circumflex humeral artery , posterior circumflex
humeral artery

63. What is Trendelenberg’s sign? Name the muscles responsible for it and give their
attachments, nerve supply and actions.
(5 marks)
Trendelenberg’s sign:
 The dropping of the unsupported side of pelvis due to defective abductor
mechanism

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Muscles:
Gluteus medius:
 Origin :gluteal surface of ilium between anterior and posterior gluteal line
 Insertion : greater trochanter of femur on oblique ridge on lateral surface

Gluteus minimus:
 Origin : Gluteal surface of ilium between anterior and inferior gluteal lines
 Insertion : greater trochanter of femur on ridge on lateral side of anterior surface

Innervations: superior gluteal nerve

Actions: -Abductors and median rotators of thigh
-Maintain balance of body when opposite foot is off the ground

64. Name the muscles of the anterior compartment of the forearm, give their actions
and nerve supply.
(2+3=5 marks)
MUSCLE NERVE SUPPLY ACTION
Pronator teres Median nerve Pronation of forearm and
flexion of elbow
Flexor carpi radialis Median nerve Flexes and abduct hand at wrist
joint, flexes the elbow
Flexor digitorum superficialis Median nerve Flexes middle phalanges of
fingers, flexes the elbow
Palmaris longus Median nerve Flexes wrist and elbow joints
Flexor carpi ulnaris Ulnar nerve Flex and adduct hand at wrist
joint, flexes the elbow
Flexor digitorum profundus Medial ½ : ulnar nerve Flex distal phalanges
Lateral ½ :anterior Chief gripping muscle, flexes
interosseous nerve the wrist
Flexor pollicis longus Anterior interosseous Flex distal phalanx of thumb,
nerve flexes the wrist
Pronator quadratus Anterior interosseous Pronates the forearm
nerve

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65. Name the bones forming the medial longitudinal arch of the foot. Mention the
factors maintaining this arch.
(1+3=4 marks)
Bones forming medial longitudinal arch:
 Heads of 1st ,2nd ,3rd metatarsal bone (anterior end)
 Medial tubercle of calcaneum (posterior end)
 Superior articular surface of talus (summit)
 Talus, navicular, 3 cuneiforms, and 1-3 metetarsal (anterior pillar)
 Medial half of calcaneum (posterior pillar)

Factors maintaining arch:

 Shape of bones: bones are wedge shaped with the sharp edge of wedge facing
downward
 Intersegmental ties that hold different segments together: spring ligament
 Tie beams that connect 2 ends of arch: plantar aponeurosis and muscles of first layer
of sole
 Slings that keep summit of arch pulled up: tibialis anterior, flexor digitorum longus
and flexor pollicis longus

66. Classify the epithelia and explain with examples.

(5 marks)
Epithelia are broadly classified into simple and compound (stratified) epithelia
Simple epithelia are made up of single layer of cells and are further classified as follows:
1. Simple squamous – alveoli of lung, lining of blood vessel, Bowman’s capsule
2. Simple cuboidal – lining of follicles of thyroid, small ducts of glands
3. Simple columnar non-ciliated – gall bladder, lining of most parts of intestine
4. Simple columnar ciliated – lining epithelium of uterus uterine tube, bronchiole,
central canal of spinal cord
5. Pseudostratified columnar epithelium –
i) Ciliated- in respiratory tract upto terminal bronchiole
6. Non-ciliated – in male urethra,
Stratified epithelia are futher classified as follows:
1. Stratified squamous non-keratinized – in mouth, esophagus, vagina, conjunctiva
2. Stratified squamous keratinized – skin

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 3. Stratified cuboidal epithelium – seminiferous tubule, ovarian follicle
4. Transitional epithelium/urothelium – ureter & urinary bladder

68. Draw a neat labeled diagram of elastic cartilage and describe briefly with examples.
(5 marks)

Elastic cartilage:
 It is covered by perichondrium which has outer fibrogenic and inner
chondrogenic layers
 Fibrogenic layer has collagen fibres and chondrogenic layer has chondroblasts
 It has an eosinophilic matrixconsisting of elastic fibres
 Chondrocytes are large, rounded and are scattered
 Chondrocytes are found in the lacunae
 Cell nests are not as obvious as in the hyaline cartilage

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  Its present in pinna of the ear, and epiglottis

69. A young dentist consults her physician, complaining that she feels tingling and slight
pain in her right hand. The symptoms are localized to her thumb, index, middle and
lateral side of her ring finger. In addition, recently she also experienced some weakness
in her grip and was finding difficulty in holding her instruments. The physician easily
diagnosed the condition and mentioned to his students that one of the nerves concerned
with innervation of hand is affected.

a. Name the nerve affected in this case.

b. Explain its distribution in forearm and hand.
c. Explain the reasons for the symptoms seen in the dentist.
(½+2½+2=5 marks)
a) Median nerve

b) Distribution:
1. In forearm
 Muscular branches given at cubital fossa to flexor carpi radialis,
Palmaris longus, and flexor digitorum superficialis
 Anterior interosseous nerve given at middle of forearm supplies flexor
pollicis longus, lateral ½ of flexor digitorum profundus and pronator
quadrates
 Palmar cutaneous branch supplies skin over thenar eminence and
central part of palm
 Articular branches to elbow and proximal radioulnar joint
 Vascular branches to radial and ulnar arteries
 Communicating branch to ulnar nerve

2. In hand
 Supplies 5 muscles; abductor pollicis brevis, flexor pollicis brevis,
opponens pollicis and 1st and 2nd lumbricals
 Palmar skin over lateral 3 ½ digits with their nail beds
c. The dentist has developed carpal tunnel syndrome due to the overuse of her wrist.
When the wrist is overused, there will be osteoarthritic changes in the flexor

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 retinaculum and this in turn will compress the median nerve. Compression of
median nerve will result in tingling sensation in the areas of its cutaneous
distribution. It will also result in weakness in gripping.

70. Name the lateral rotators of the arm. Mention the attachments and nerve supply
of one of them.
(2½ marks)
Lateral rotators of the arm:
 Infraspinatus
 Supraspinatus

Infraspinatus:
 Origin : medial 2/3 of infraspinatus fossa of scapula
 Insertion : greater tubercle of humerus
 Nerve supply : suprascapular nerve

71. Write briefly about the major superficial veins of the upper limb.
(4 marks)
Cephalic vein
 Preaxial vein of upper limb and it begins from lateral end of dorsal venous arch
 It drains into axillary vein
Basilic vein
 Postaxial vein of upper limb and begins from medial end of dorsal venous arch
 At the lower border of teres major it becomes axillary vein
Median cubital vein
 Large communicating vein that shunts blood from cephalic to basilic vein
Median vein of forearm
 Begins from palmar venous network and ends in any one of the vein in front of
elbow mainly in median cubital vein
(Please refer the previous answers on cephalic and basilica veins)

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72. Describe the infraclavicular part of brachial plexus.
(3 marks)
Infra-clavicular part of brachial plexus is made up of chords and branches of brachial plexus
Lateral cord- formed by union of ventral divisions of upper and middle trunks
Branches: lateral pectoral nerve
Musculocutaneous nerve
Lateral root of median nerve
Medial cord- formed by union of ventral division of lower trunk
Branches: medial pectoral nerve
Medial cutaneous nerve of arm
Medial cutaneous nerve of forearm
Ulnar nerve
Medial root of median nerve
Posterior cord-formed by union of dorsal divisions of all 3 trunks
Branches: upper subscapular
Thoracodorsal nerve
Lower subscapular
Axillary nerve
Radial nerve

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72. With a labeled diagram explain the microscopic structure of lymph node.
(4 marks)

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Lymph node:
 Has a thin capsule made up of collagen fibres
 Trabeculae extend from the capsule into the node
 It has cortex and medulla
 The lymphocytes in the cortex are arranged in the form of lymphatic nodules
 Each nodule has a deeply stained peripheral zone and a lightly stained cenral
zone called germinal centre
 Lymphocytes in the medullar are arranged in the form of lymphatic cords
 Medualla also contains blood vessels
 Lymph node consists of subcapsular, peri trabecular and medullary lymph
sinuses in which th lymph flows from cortex to medulla

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73. Write short notes on:
a. Rotator cuff
b. Femoral sheath
(2½+3 = 5½ marks)
a. Rotator cuff:

 Its a fibrous sheath formed by 4 flattened tendons which blend with capsule of
shoulder joint
 Muscles which form the cuff originates from scapula and are inserted into greater and
lesser tubercles of humerus
 The muscles are supraspinatus, infraspinatus, teres minor and subscapularis
 The cuff gives strength to capsule all around except inferiorly

b. femoral sheath:

 It is funnel shaped sleeve of fascia enclosing upper 3-4 cm of femoral vessels

 Is formed by downward extension of 2 layers of fascia of abdomen
 Anterior wall is formed by fascia transversalis and posterior wall is formed by fascia
iliaca
 It is divided into 3 compartments:

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  Lateral compartment: has femoral artery and femoral branh of genitor femoral
nerve

 Intermediate compartment: has femoral vein

 Medial compartment : known as femoral canal

74. Draw a neat labeled diagram of spinal ganglion showing the microscopic structure.
(2 marks)

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75. With a labeled diagram explain the features of superior end of femur.
(4 marks)

Superior end of femur consist of following parts:

 Head: It articulates with acetabulum to form hip joint (ball and socket joint)
Has a roughened pit below and behind centre of head called fovea capitis
 Neck: Connects head with shaft
It makes an angle of about 125◦ with shaft in adult
It is intracapsular
 Greater trochanter: Large quadrangular prominence at upper part of junctionof neck
and shaft
It gives attachment to gluteus medius, minimus, piriformis, superior
and inferior gemelli, obturator internus and externus, quadratus femoris
muscles
 Lesser trochanter: Conical eminence directed medially and backwards from junction
of posteroinferior part of neck with shaft
It gives attachment to the psoas minor muscle
 Intertrochanteric line: a roughened ridge which begins at anterosuperior angle of
greater trochanter as a tubercle and continuous below with
spiral line in front of lesser trochanter
It gives attachement to capsule of hip joint and ileofemoral
ligament
 Intertrochanteric crest- it is a smooth rounded ridge which begins at posterosuperior
angle of greater trochanter and ends at lesser trochanter

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76. Describe the intra-articular ligaments of knee joint.
(5 marks)
 Cruciate ligaments (anterior and posterior)
Thick and strong fibrous bands that act as a direct bond of union between tibia and
femur

Anterior cruciate ligament:

Lower attachment: anterior part of intercondylar area of tibia
Upper attachment: posterior part of medial surface of lateral condyle of femur
Posterior cruciate ligament:
Lower attachment: Posterior part of intercondylar area of tibia
Upper attachment: anterior part of laterla surface of medial condyle of femur
Function: act as direct bond of union between tibia and femur. Maintain
anteroposterior stability of knee joint
Function: acts as direct bond of union between tibia and femur. Maintains
anteroposterior stability of knee joint

 Menisci ( medial and lateral )

Fibrocartilagenous discs
They deepen articular surfaces of condyles of tibia and partially divide joint cavity
into upper and lower compartment
They also help to distribute the synovial fluid in the joint

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Medial meniscus:
 fibrocartilagenous disc
 nearly semicircular
 its wider behind than in front
 posterior fibres of anterior end are continuous with transverse
ligament
 its peripheral margin is adherent to deep part of tibial collateral
ligament
Lateral meniscus:
 fibrocartilagenous disc
 nearly semilunar

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  its wider behind than in front
 anterior fibres of anterior end are continuous with transverse
ligament
 its peripheral margin is adherent to the tendon of popliteus

77. A medical student was playing football with his friends. After kicking the ball hard
(with the extended knee), he felt severe pain in the back of thigh and was unable to
move his legs. On examination, the physician observed that his major muscles of
thigh were torn.
a. What are those muscles?
b. Explain the origin, insertion, nerve supply and actions of these muscles.
(1+4=5 marks)
a) Hamstring muscles

b) Semitendinosus
 Origin : ischial tuberosity
 Insertion : upper part of medial surface of tibia
 Nerve supply: tibial component of sciatic nerve
 Action: chief flexor of knee, extensor of the hip
Semimembranosus
 Origin : ischial tuberosity
 Insertion : groove on posterior surface of medial condyle of tibia
 Nerve supply: tibial component of sciatic nerve
 Action: chief flexor of knee, extensor of the hip
Long head of biceps femoris
 Origin : ischial tuberosity
 Insertion: head of fibula
 Nerve supply: tibial component of sciatic nerve
 Action: chief flexor of knee, extensor of the hip
Adductor Magnus (hamstring part)
 Origin : ischial tuberosity
 Insertion : adductor tubercle and linea aspera
 Nerve supply: tibial component of sciatic nerve
 Action: Extensor of the hip

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78. A 27 year old lady during her second trimester of pregnancy visited her
gynaecologist complaining that she had per vaginal bleeding. After examination,
the doctor explained that the blastocyst has implanted at an abnormal site and
consequently the developing placenta has bridged the opening of internal os.

a. What is this condition known as?

b. What is the normal site of implantation?
c. Add a note on implantation.
(2+1+2=5 marks)
a) Placenta previa

b) Normal:
 posterior wall of fundus of uterus
 anterior and posterior walls of body of uterus

c) Implantation:
 begins at the end of 1st week and is completed in 2nd week
 the 1st event is the disappearance of zona pellucida (zp)
 zp prevents blastocyst from getting implanted in abnormal site
 after zp is removed, blastocyst adheres to endometrium
 the cells of blastocyst digest endometrium and make a hole in it which allows the
blastocyst to go deeper into endometrium
 then the endometrium grows over and cover it

79. a. Explain the parts of a developing long bone.

b. Briefly describe the types of epiphysis with examples.
(3+2=5 marks)
a) Parts of a developing bone
 epiphysis-end and tip of a bone which ossify from secondary centres
 diaphysis-elongated shaft of long bone
 metaphysic-epiphysial end of diaphysis
 epiphysial plate of cartilage-separates epiphysis from metaphysic

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b)
TYPE OF EPIPHYSIS EXAMPLE
Pressure epiphysis-articular and take part in Head of femur
weight transmission
Traction epiphysis-provide attachment to one Trochanters of femur
or more tendons
Atavistic epiphysis-independant bone (in Corocoid process of scapula
ancestors) which becomes fused with another
bone for functional reasons
Aberrant epiphysis-not always present Head of 1st metacarpal

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80. Write short notes on:
a. Somite
b. Neural crest cells
c. Morula
(2+2+2=6 marks)
a) Somite

By the beginning of the 3rd week, the paraxial mesoderm becomes organized into brick like
unites or segments called ' somitomeres ' or ' somites '. The formation of the somites begins in
the cephalic region of the embryo and proceeds craniocaudally. The first pair of somites
appear on the 20th day of development. From here, approximately 3 pairs of somites appear

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per day till the end of 5th week. At the end, a total number of 42-44 pairs are formed. There
will be 4 occipital, 7 cervical, 12 thoracic, 5 lumbar, 5 sacral and 8-10 coccygeal pairs. Later,
first occipital and 5-7 coccygeal somites disappear. The period of IUL where the somites are
formed is called 'somite period' and during this period, the age of the embryo could be given
by counting the somites. The somites give rise to the axial skeleton of the body.

Fate of the somites:

The somites start to differentiate in the 4th week of the intrauterine life. Initially there lies a
small cavity in the centre of the somite. The dorsolateral part of the somite is called
'dermomyotome' and the ventromedial part of the somite is called 'sclerotome'. The
dermomyotome divides into two parts. The peripheral part is called 'dermatome' and central
part is called 'myotome'. The dermatome forms the dermis of the skin. It will fuse with the
overlying ectoderm to form the skin. The myotome forms the segmental muscles which are
attached to the vertebral column. The cells of the sclerotome move medially and cover the
notochord and the neural tube. These cells of the sclerotome will form the vertebral column.
Only the 'nucleus pulposus' part of the intervertebral disc is formed by the notochord. All the
other elements of the vertebral column are formed by the sclerotome.

b) Neural crest cells:

 Neural crest is the junction between ectoderm and the neuroectoderm
 When neural plate fold to formneural tube, neural crest come to lie dorsolateral to
neural tube
 The neural crest cells become loose and migrate all over embryo
 Derivatives: spinal and autonomic ganglia, Schwann cells, melanocytes, pia and
arachnoid mater, medulla of suprarenal gland

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c) Morula
 The zygote divided mitotically until it forms 16 cell structure called morula
 It resembles a mulberry fruit
 Its cells are called blastomeres
 When the morula reaches the uterine cavity, uterine fluid enters the morula and
displaces the cells peripherally
 A cavity filled with fluid appears in the morula
 At this stage it is called a blastocyst
 Morula is surrounded by zona pellucida to prevent it from implanting at abnormal site

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81. Explain the structure of a Graafian follicle with the help of a neat labeled diagram.
(4 marks)

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Graffian follicle:
It is also known as a tertiary follicle, or vesicular follicle. It measures 10-15mm in diameter.
It has a follicular antrum, filled with follicular fluid. The follicular antrum is surrounded by
granulosa cells. The granulosa cells surrounding the oocyte are called cumulus oophorus.
The oocyte is separated from the granulosa cells by a glycoprotein called zona pellucida. The
granulosa cells are surrounded by theca interna and theca externa. The theca interna is
glandular and secretes estrogen. The theca externa is made up of connective tissue. It is
protective in function.

82. A 35-year-old man met with an automobile accident. Apart from other superficial
injuries, he was found to have a fracture of the neck of right femur. On
examination, his right lower limb showed 2 inches of shortening and it was rotated
laterally which was indicated by the lateral pointing of the toes.
a. What are the muscles responsible for the lateral rotation of leg in this person
and mention their nerve supply
b. Why there was a shortening of the right limb?
(3+1=4 marks)

a. Muscles responsible for lateral rotation of the leg and their nerve supply is as
follows
Gluteus maximus – superior gluteal nerve
Adductor magnus – obturator and sciatic nerves
Adductor longus – obturator nerve
Adductor brevis – obturator nerve
Psoas major nerve – roots of L2, L3 and L4 spinal nerves
b. Reason for shortening of the limb:

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 When the neck of femur gets fractured, the connection between the acetabulum and
the shaft of the femur is lost. The muscles attached to the greater trochanter (mainly
gluteus maximus, medius and minimus muscles) pull the femur upwards. This
causes the pulling of entire lower limb upward and shortening it.

83. Write short notes on:

a. Medial longitudinal arch
b. Profunda femoris artery
(3½+2½=6 marks)
a) Medial longitudinal arch

Anterior end Heads of 1st, 2nd, 3rd metatarsal bones

Posterior end Medial tubercle of calcaneum
Summit Superior articular surface of talus
Anterior pillar Talus, Navicular,3 cuneiform, and 1-3 metatarsal
Posterior pillar Medial half of calcaneum
Main joint Talocalcaneonavicular joint
Factors maintaining the arches
Bony factor Wedge-shaped
Intersegmental ties Spring ligament
Tie beams Plantar aponeurosis
Abductor hallucis
Slings Tibialis posterior
Flexor hallucis longus
Flexor digitorum longus

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b) Profunda femoris artery
 Largest branch of femoral artery
 Chief artery that supplies all 3 compartments of thigh
 Origin: lies in front of iliacus
 Course :
-it descends by passing deep to femoral vessels
-leaves femoral triangle by passing deep to adductor longus
-then it passes first between adductor longus and brevis, then between adductor
longus and magnus to anastomose with upper muscular branches of popliteal arteries
 Branches :
-medial and lateral circumflex femoral branches
-4 perforating branches

84. A 20-year-old girl, pillion rider on a motorcycle, was involved in an accident.

Radiograph of her left leg revealed the fibular neck fracture. Her left foot was in
the plantar flexed and inverted position.
a. Give reasons for position of her left foot
b. Mention the major muscle of posterior compartment of leg which is responsible
for inversion of foot. Add a note on its attachments, nerve supply and joints on
which it acts.
(1½+3½=5 marks)
a) Reasons:
 the left common peroneal nerve is injured
 the nerve supplies muscles of anterior compartment of leg which is responsible for
dorsiflexion of foot and muscles of lateral compartment that is responsible for
evertion of foot. Paralysis of these muscles results in plantar flexion of foot (foot
drop) and inversion of foot

b) Tibialis posterior
 origin : upper 2/3 of lateral part of posterior surface of tibia below soleal line
 insertion : tuberosity of navicular bone and other tarsal bone except talus
 nerve supply : tibial nerve
 joints : ankle joint, subtalar joint, talocalcaneonavicular joint

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85. Write short notes on:
a. Epiphysis
b. Multipolar neuron
(2+3=5 marks)
a) Epiphysis

 Epiphysis is the end and tip of bone which ossifies from secondary centre
 Its fusion with diaphysis takes place around puberty
 Types :
TYPE OF EPIPHYSIS EXAMPLE
Pressure epiphysis-articular and take part in Head of femur
weight transmission
Traction epiphysis-provide attachment to one Trochanters of femur
or more tendons
Atavistic epiphysis-independant bone which Corocoid process of scapula
becomes fused with another bone
Aberrant epiphysis-not always present Head of 1st metacarpal

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b) multipolar neuron

Multipolar neuron consists of:

 A cell body with eccentric nucleus and
 Nissl granules are seen in its cytoplasm
 Cell processes are of 2 types: dendrites and axons
 Dendrites are many short afferent processes
 Axon is a single long efferent process
 Terminal branches of axon are called axon terminals or telodendria
 Axon is covered by the Schwann cells in the peripheral nervous system

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  The exposed part of the axon between the two Schwann cells is called node of
Ranvier
 The areas between the two nodes is called internode
 Schwann cells produce myelin sheath
 Myelin sheath which provides insulation

86. With the help of diagram describe the structure of a typical synovial joint.
(4 marks)
 Please refer the previous answers

87. Tony never been an athlete, participated in college athletic meet for throwing
sports. He got a sudden pain associated with an audible snap in the area of his
shoulder. When he attempted to flex his elbow, a bulge was seen anteriorly in the
middle of the arm.
a. Name the muscle that is injured
b. Give the origin, insertion, nerve supply and actions of it.
(1+1+1+1+1=5 marks)
a) Biceps brachii
b) Origin:
Long head: supraglenoid tubercle of scapula
Short head: corocoid process

Insertion: posterior rough part of radial tuberosity

Nerve supply: musculocutaneous nerve

Actions: strong supinator when forearm is flexed

Flexes the elbow
Short head flexes the arm
Long head prevents upward displacement of humerus

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88. A patient came to OPD with disability of the hand. On examination, the duty
doctor found the medial four fingers in clawed position. There was wasting of
hypothenar and thenar eminences and hollowed out appearance of web space
between the thumb and the index finger. With your knowledge in anatomy,
a. Name the nerves affected.
b. Give the root values of the nerves affected.
c. Write the course and distribution of any one of those nerves.
(1+1+1+2=5 marks)
a) Ulnar nerve and median nerve
b) ulnar-C7, C8, T1 median-C5, C6, C7, C8, T1
c) Ulnar nerve
Course:
 In axilla it lies between axillary vein and artery then runs downward with brachial
artery in proximal part
 At middle of arm it pierce medial intermuscular septum to lie in its back and descends
behind medial epicondyle of humerus
 It enters forearm by passing between 2 heads of flexor carpi ulnaris and lies on medial
part of flexor digitorum profundus
 It is accompanied by ulnar artery in lower 2/3 of forearm and gives 2 muscular
branches and 2 cutaneous branches
 Then it lies on medial part of flexor retinaculum to enter palm
 At distal border of retinaculum it divides into superficial and deep branches
Distribution:
 In the forearm
Muscular: medial ½ of flexor digitorum pfofundus, flexor carpi ulnaris
Cutaneous: dorsal cutaneous branch for medial half of dorsum of hand
palmar cutaneous branch for medial 1/3 of palm
digital branches to medial 1 ½ fingers, nail beds and dorsal distal
phalanges
Vascular/articular: supply digital vessels and joints of medial side of hand
 In the hand:
Muscular: superficial branch supplies palmaris brevis
Deep branch supplies hypothenar eminence, medial 2 lumbricals, dorsal
and palmar interossei and adductor pollicis

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89. Explain the shoulder joint under the following headings,
a. Type
b. Capsule
c. Movements and muscles producing each of them
(1+1+3=5 marks)
a) Synovial (ball and socket)
b) Capsule:
 Very loose and permits free movements
 Least supported inferiorly where dislocations are common and the dislocation may
cause damage to axillary nerve
 Lined with synovial membrane the extension of the membrane forms a tubular sheath
for tendon of long head of biceps brachii
c) Movements:
MOVEMENT MUSCLES
Flexion  Clavicular head of pectoralis major
 Anterior fibres of deltoid
Extension  Posterior fibres of deltoid
 Latissimus dorsi
Adduction  Pectoralis major
 Latissimus dorsi
 Short head of biceps brachii
 Long head of triceps brachii
Abduction  Suprapinatus (0◦-15◦)
 Deltoid (15◦-90◦)
 Serratus anterior (90◦-180◦)
 Upper and lower fibres of trapezius (90◦-
180◦)
Medial rotation  Pectoralis major
 Anterior fibres of deltoid
 Latissimus dorsi
 Teres major

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 Lateral rotation  Posterior fibres of deltoid
 Infraspinatus
 Teres minor

90. With the help of a labeled diagram explain the microscopic structure of transverse
section of compact bone.
(4 marks)

Please refer the previous answers

91. Draw a neat labeled diagram of microscopic structure of spleen

(2 marks)

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92. A 28 year old woman, who has been a heavy cigarette smoker since her teens was
informed that she was in the fourth week of pregnancy and was advised to quit her
smoking habit and the use of drugs.

a. What is the significance of this period of development?

b. Name any one neural tube defect which can occur during this period.
c. Mention any five derivatives of neural crest cells.
(2+1+2=5 marks)
a) Significance:
 The 3 germ layers ectoderm, mesoderm,and endoderm begin to give rise to its own
tissue and organ systems
 Formation of somites
 Formation of neural tube
 Formation of neural crest cells
b) Anencephaly, spina bifida
c) Derivatives of neural crest cells:
 Cranial nerve ganglia
 Spinal and sympathetic ganglia
 Schwann cells
 Glial cells
 Melanocytes
 Adrenal medulla

93. Briefly describe the various stages in the formation of chorionic villi.
(5 marks)
 In 2nd week of IUL, tropoblast differentiates into 2 layers, outer syncytiotropoblast
and inner cytotropoblast
 As the syncytiotropoblast grows, small cavities called lacunae appear in it
 Soon the cavities become larger and the area between the cavities are called trabecula
 With these changes occurring, syncytiotropoblast grows into deciduas and erodes
endometrial blood vessels causing blood from the vessels to fill the lacunae
 Each trabeculus is initially only made of syncytiotropoblast
 Later cells of cytotropoblast multiply and grow into syncytiotropoblast

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  The trabeculus thus will have a central core of cytotropoblast and a peripheral part of
syncytiotropoblast and it is called primary villus
 The extraembryonic mesoderm lining the tropoblast then erodes the core of primary
villus and now the villus has a central core of mesoderm and peripheral cyto and
syncytiotropoblast, which is known as secondary villus
 Then blood vessels appear in mesoderm of villus and is known as tertiary villus
 Since the tropoblast and the underlying mesoderm constitutes chorion, the villi are
known as chorionic villi

94. Write short notes on:

a. Corpus luteum
b. Somite
(2½+2½=5 marks)
Please refer the previous answers

95. Classify the cartilaginous joints. Give one example for each type. Describe the
features of synovial joints.
(1+1+3= 5 marks)
CLASSIFICATION EXAMPLE
Primary cartilaginous joint Costochondral joints
Secondary cartilaginous Symphysis pubis
joint

Features of synovial joints:

Please refer the previous answers

Durga & Sathis

96. With a labeled diagram explain the histology of spleen.
(5 marks)

 It has a thick capsule and trabeculae with connective tissue elements

 The capsule is covered by serosa which is the visceral layer of peritoneum
 Splenic pulp consisting of :
 Red pulp: with RBC and WBC mainly lymphocytes and some monocytes

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  White pulp: the splenic corpuscles or lymphoid follicles constitute the white
pulp
 Splenic corpuscles-scattered lymphoid nodules which are aggregation of lymphoid
tissue with an eccentric arteriole in their substance
 It has no prominent cortex and medulla
 It has no sinuses
 The red pulp contains the extension of trabeculae carrying blood vessels

97. Describe the parts of developing/immature long bone.

(5 marks)
Please refer the previous answers

98. Write short notes on:

a. Cephalic vein
b. Distal end of humerus
c. Trapezius muscle
(2½+2½+5=10 marks)
a) Cephalic vein:
 Preaxial vein of upper limb
 Begins from lateral end of the dorsal venous arch
 It runs upward through roof of anatomical snuffbox and winds around lateral border
of distal part of forearm
 It then continues upward in front of elbow and pierces deep fascia at lower border of
pectoralis major and runs in the deltopectoral groove
 Then it pierces clavipectoral fascia and joins axillary vein

b) Distal end of humerus

 It forms a condyle which is expanded from side to side and has a
 Articular part consisting of :
-capitulum which articulates with head of radius
-trochlea which is a pulley shaped surface that articulates with trochlear notch of ulna
 Nonarticular part:
Has a medial epicondyle which is a prominent bony projection on medial side. It
gives attachment to the common flexor tendon

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 Has a lateral epicondyle which is smaller than medial epicondyle. It gives attachment
to common extensor tendon
Has a lateral supracondylar ridge which is a sharp lateral margin above lower end. It
gives attachment to lateral intermuscular septum, brachioradialis and extensor carpi
radialis longus muscles
Has a medial supracondylar ridge on medial side. It gives attachment to the medial
intermuscular septum
Has a coronoid fossa, which a depression above anterior aspect of trochlea, It
accommodates the coronoid process of ulna at the end of full flexion of the elbow
Has a radial fossa, which is a depression just above anterior aspect of capitulum. It
accommodates the head of radius during full flexion of elbow
Has olecronon fossa which lies above posterior aspect of trochlea. It accommodates
the olecranon process of ulna at the end of extension of elbow

c) Trapezius muscle:
 Medial 1/3 of superior nuchal line
ORIGIN  External occipital protuberance
 Ligamentum nuchae
 Upper fibres: posterior border of lateral 1/3 of clavicle
 Middles fibres: medial margin of acromion and upper lip
INSERTION
of crest of spine of scapula
 Lower fibres: deltoid tubercle at medial end of spine
Motor: spinal part of accessory nerve
NERVE SUPPLY
Proprioceptive: C3 ,C4
 Upper fibres elevate scapula with levator scapulae
 Middle fibres retract scapula with rhomboideus
ACTIONS  Steadies scapula
 Upper and lower fibres are involved in abduction beyond
90◦

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99. Explain the origin, root value, course and termination of median nerve. Write a
note on its distribution in the hand.
(½+½+1½+½+2=5 marks)
 It is formed by 2 roots, lateral root of median nerve from
ORIGIN lateral cord and medial root of median nerve from the
medial cord of brachial plexus
ROOT VALUE  C5, C6, C7, C8 and T1
 In axilla, the nerve runs on lateral side of axillary artery
 In arm, it continues to run on lateral side of brachial
artery till middle of arm where it crosses in front of the
artery, passes anterior to elbow joint and into forearm
 In forearm, it pass through cubital fossa lying medial to
COURSE brachial artery
 It leaves the fossa by passing between 2 heads of pronator
teres, then deep to flexor digitorum superficialis
 Then it is placed deep and lateral to palmaris longus to
enter palm under flexor retinaculum
 In palm, it lies medial to muscles of thenar eminence
 It ends by dividing into muscular and cutaneous branches
TERMINATION
in the palm

Distribution in hand:
 Muscular branches:
 Recurrent branch for abductor pollicis brevis,flexor pollicis brevis, opponens
pollicis, branches to 1st and 2nd lumbricals from the digital nerves
 Cutaneous branch :
 2 digital branches to lateral and medial sides of thumb
 1 to lateral side of index finger
 1 to adjacent sides of index and middle fingers
 1 to adjacent sides of middle and ring fingers. These branches also supply
dorsal aspect of distal phalanges of lateral 3 ½ fingers
 Articular and vascular branches :
 Gives vascular and articular branches to joints of hand

Durga & Sathis

100. An 18-year-old boy while playing foot ball, collided with another player and fell to
the ground with his knee joint flexed. Upper end of his right tibia hit the ground
and his right knee was hyperflexed. On examination of his knee it was diagnosed
that one of the intra-articular structure in the knee was injured.
a. Which intra-articular structure in the knee was damaged? Write a note on that
structure.
b. Describe the movements of knee joint.
(1+2+3=6 marks)
a) Posterior cruciate ligament:
Lower attachment: Posterior part of intercondylar area of tibia
Upper attachment: anterior part of laterla surface of medial condyle of femur
Function: act as direct bond of union between tibia and femur. Maintain anteroposterior
stability of knee joint
Function: acts as direct bond of union between tibia and femur. Maintains anteroposterior
stability of knee joint
b) Movements at knee joint
 Flexion and extension :
 Take place in upper compartment of joint above menisci
 Transverse axis around which the movement take place is not fixed
 Movement is invariably accompanied by rotations
 Rotation
 Takes place around vertical axis in the lower compartment of joint below
menisci
Muscles involved in movements:
MOVEMENTS MUSCLES
Flexion  Biceps femoris
 Semitendinosus
 Semimembranosus
Extension  quadriceps femoris
Medial rotation of flexed leg  popliteus
 semimembranosus
 semitendinosus
Lateral rotation of flexed leg  biceps femoris

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101. A 25 year old man was admitted to the hospital following an automobile accident.
He was found to have a fracture of the lower part of the shaft of right femur. On
examination, the right leg showed 2 inches of shortening. A lateral radiograph
showed overlap of the fragments, with the distal fragment rotated backward.
a. Mention the major artery of the lower limb which can be compressed by the
backwardly rotated distal fragment of femur.
b. Explain the origin, course and termination of that artery. Mention its branches.
(1+1+1+1+1=5 marks)
a) Popliteal artery
b)
 Continuation of femoral artery at
ORIGIN
hiatus magnus
 Runs downwards and slightly
COURSE laterally to reach lower border of
politeus
 At the lower border of popliteus by
TERMINATION dividing into anterior and posterior
tibial arteries
 Muscular
 Cutaneous
BRANCHES  5 genicular branches: 2 superior, 1
middle and 2 inferior
 Anterior and posterior tibial arteries

102. Write a note on lateral longitudinal arch of foot.

(4 marks)
 Lateral longitudinal arch is lower than medial longitudinal arch, has a limited
mobility, used mainly to transmit weight
ANTERIOR END  Head of 4th and 5th metatarsals
POSTERIOR END  Lateral tubercle of calcaneum
 Articular facet on superior surface of calcaneum at level
SUMMIT
of subtalar joint
ANTERIOR PILLAR  Cuboid

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  4th and 5th metatarsals
POSTERIOR PILLAR  Lateral ½ of calcaneum
MAIN JOINT  Calcaneocuboid joint
BONY FACTOR  Wedge-shaped
INTERSEGMENTAL  Long plantar ligament
TIES  Short plantar ligament
 Planta aponeurosis
TIE BEAMS
 Abductor digiti minimi
 Peroneus longus
SLINGS
 Peroneus brevis

103. An embryo with growth retardation and anomalies in central nervous system was
observed because of triploid conception. It was found out that more than 2 sperm
were involved in fertilization.
a. What is the condition known as? What is zona reaction?
b. Write a note on the process of fertilization.
(2+3=5 marks)
a) Polyspermy
Zona reaction is when the zona changes its property and becomes impermeable for other
Sperms due to cortical reaction
b) Fertilization:
 It is fusion of sperm and secondary oocyte
 It occurs in the ampulla of the uterine tube
 It is likely to occur in the middle of menstrual cycle
 Ovulation occurs on the 14th day and spermatozoa survives in female genital tract for
about 4 days and the ova can survive for 2 days
 So sexual intercourse anywhere between 4days before ovulation and 2 days after
ovulation is likely to result in fertilization
Stages of fertilization:
 Penetration of corona radiata: 200 300 million sperms are deposited in the female
genital tract at the end of sexual intercourse. Among them, 300 500 reach the site of
fertilization. Though only one sperm is needed to fertilize the oocyte, it is believed
that the mass movement favors the fertilization. The capacitated sperms which reach

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 the site of fertilization, penetrate through the corona radiata. This is also favored by
the enzymes released by the acrosome.
 Penetration of zona pellucida: Zona pellucida is the glycoprotein coat that covers the
oocyte. When the sperms touch the zona pellucida, the zona induces the acrosome
reaction. When one of the sperms touches the oocyte membrane, some lysosomal
enzymes are released by cortical granules which are lining the oocyte membrane. This
reaction is called cortical reaction. Because of the cortical reaction, the zona changes
its property and becomes impermeable to the other sperms. This is called zona
reaction. This prevents fusion of many sperms with ovum.
 Fusion of sperm and oocyte membranes: In this stage, the membranes of two cells
fuse. Both tail and head of the sperm enter the cytoplasm of the oocyte. Only the
plasma membrane is left behind.

104. With a neat labeled diagram describe the structure of spermatozoon.

(5 marks)

Structure of spermatozoon:
A sperm has a head (caput), neck (cervix), and a tail (cauda) which is divided into middle
piece, principle piece, and an end piece.
 Head : consists of a large nucleus with homogenous chromatin and has no cytoplasm
-its terminal 2/3 is covered by a laminar acrosomal cap
-acrosome has acid phosphatase, protease and hyaluronidase enzyme needed
for penetration of oocyte during fertilization

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 -nucleus and acrosome are covered by plasma membrane without intervening
cytoplasm
 Neck : -constricted part between head and middle piece
-at base of nucleus there is proximal centriole
-has small amount of cytoplasm
 Middle piece: -contains axial bundles or microtubules
-surrounded by mitochondrial sheath which has mitochondria in it
-axial bundle is mad e of a central pair of filaments surrounded by 9
pair of peripheral filaments and outer to this there are 9 coarser fibrils
-at caudal end there is an annulus (distal centriole)
 Principle piece : -motile part of sperm
-its terminal part is called tail piece and resembles a flagellum

105. Write short notes on:

a. Definitive yolk sac
b. Corpus luteum
(2+3=5 marks)
a) Definitive yolk sac

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  Before the formation of the extraembyonic mesoderm, the yolk sac is called primary
yolk sac or exocoelomic cavity
 With the formation of extrembryonic mesoderm, a new layer of cell is laid
down by hypoblast
 This cell layer forms the boundaries of the newly formed cavity and this cavity
is known as definitive yolk sac
 Function
 It serves a nutritive roll till the placenta is formed
 It is the site of development of blood cells and primordial germ cell

 Fate: when the embryonic disc folds, a part of yolk sac is incorporate into the embryo
as the gut tube. Remaining part detaches from gut in second half of gestation and
degenerates

b) Corpus luteum
 Please refer the previous answers

Durga & Sathis

106. A 60 year old man who was using crutches for past few weeks, complained about
his inability to extend his elbow, wrist joints and fingers. On examination it was
observed that he had loss of skin sensation along the posterior surface of lower part
of arm and a narrow strip on the back of forearm. Sensory loss was also seen on
the dorsum of hand and on the dorsal surface of the roots of lateral three and a
half fingers.

a. Name the nerve injured.

b. Give its root value, course, termination & distribution.
c. Name the clinical conditions resulting from its injury.
(½+½+1+½+2+½=5 marks)
a) Radial nerve
b)
ROOT VALUE  Ventral rami of C5, C6, C7, C8 and T1
 In axilla it lies against muscles forming posterior wall of axilla
 Then it lies in lower triangular space
 Through the lower triangular space it enters the radial sulcus
where it lies between long and medial head of triceps brachii
with profunda brachii artery
COURSE
 Then it pierces lateral intermuscular septum and enters lower
anterolateral part of arm and lies between brachialis on medial
side and brachioradialis with extensor carpi radialis longus on
lateral side
 Then the nerve descends to reach cubital fossa
 It ends in cubital fossa by dividing into 2 terminal branches
TERMINATION
which is superficial and deep/posterior interosseous branches
 In axilla supply long and medial head of triceps brachii and
gives posterior cutaneous nerve
 In radial sulcus supplies lateral and medial head of triceps
brachii and anconeus and gives posterior cutaneous nerve of
DISTRIBUTION
forearm , lower lateral cutaneous nerve of arm, vascular branch
to profunda brachii artery
 Posterior interosseous branch
 Supplies extensor carpi radialis brevis

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  Supinator
 Abductor pollicis longus
 Extensor pollicis brevis
 Extensor pollicis longus
 Extensor digitorum
 Extensor indicis
 Extensor digiti minimi
 Extensor carpi ulnaris
 Branches from its pseudoganglion supply wrist joint
 Superficial branch:
 Supplies skin of lateral half of dorsum of hand, lateral 2
½ digit till distal interphalangeal joint

c) Clinical condition: wrist drop

107. Write short notes on:

a. Superficial palmar arch
b. Flexor retinaculum
(2½+2½=5 marks)
a) Superficial palmar arch
 Formation:
By superficial palmar branch of ulnar artery (superficial palmar branch is also
known as the direct continuation of the ulnar atery
The arch is completed on the lateral side by superficial palmar branch of
radial artery
 Relation: lies deep to palmaris brevis and palmar aponeurosis
Lies superficial to the long flexor tendons
 Branches : give 4 digital branches to supply medial 3 ½ fingers
Lateral 3 digital branches are joined by corresponding palmar
metacarpal arteries from deep palmar branch

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b) Flexor retinaculum:

 Strong fibrous band which bridges the anterior concavity of carpus and converts it to a
tunnel, carpal tunnel
 Attachment:
Medially  Pisiform bone
 Hook of hamate
Laterally  Tubercle of scaphoid
 Crest of the trapezium
 It has a slip on either sides:
-lateral deep slip for the tendon of flexor carpi radialis

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 -medial superficial slip or volar carpal ligament for the passage of ulnar nerve and
vessels

Relations of flexor retinaculum:

 Superficial relations: ulnar nerve, ulnar artery, superficial palmar branches of median
and ulnar nerves, tendon of palmaris longus
 Deep relations: carpal tunnel and its contents namely, median nerve, tendons of flexor
digitorum profundus and flexor digitorum superficialis, tendon of flexor pollicis
longus, radial and ulnar bursae

Durga & Sathis

108. Explain axillary artery under the following headings:
a. Extent
b. Relations
c. Branches
(1+2+2=5 marks)
st
a) Extent: from outer border of the 1 rib to the lower border of teres major

b) Relations:
 1st part
-laterally: lateral cord and posterior cord of brachial plexus
-posteriorly: medial cord of brachial plexus
 2nd part
-laterally: lateral cord of brachial plexus
-medially: medial cord of brachial plexus
-posteriorly: posterior cord of brachial plexus
 3rd part
-laterally: musculocutaneous nerve (upper part), median nerve (lower part)
-medially: medial cutaneous nerve of forearm, ulnar nerve, axillary vein, medial
cutaneous nerve of arm
-posteriorly: axillary nerve (upper part), radial nerve (lower part)

c) Branches:
 1st part : superior thoracic artery
 2nd part: thoracoacromial artery , lateral thoracic artery
 3rd part : subscapular artery, anterior circumflex humeral artery, posterior circumflex
humeral artery

109. a. Write short note on the structure of a typical synovial joint.

b. Classify the synovial joints with examples.
c. Mention any two factors which maintain stability of joint.
(2+2+1=5 marks)
For parts a and b, please refer the previous answers
c) Factors maintaining stability of joint:
 Tone of different groups of muscles acting on the joint

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  Ligaments which prevent any over movement and guard the joint against sudden
accidental stress
110. Name the types of bones. Write a brief note on parts of the developing long bone.
(1+4=5 marks)
Types of bone based on shape and consistency:
Long bones
Short bones
Short long bone
Flat bones
Irregular bones
Pneumatic bone
Sesamoid bone
Accessory (supernumery)
bone
Heterotopic bones

Parts of developing young bones:

 epiphysis-end and tip of a bone which ossifies from secondary centres
-types of epiphysis
TYPE OF EPIPHYSIS EXAMPLE
Pressure epiphysis-articular and takes part in Head of femur
weight transmission
Traction epiphysis-provides attachment to Trochanters of femur
one or more tendons
Atavistic epiphysis-independant bone in Corocoid process of scapula
lower animals, but becomes fused with
another bone to form a part of that bone in
humans
Aberrant epiphysis-not always present Head of 1st metacarpal

 diaphysis-elongated shaft of long bone

 metaphysis- epiphysial end of diaphysis
-each one is a zone of active growth
 epiphysial plate of cartilage-separates epiphysis from metaphysis

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 -proliferation of cells in this part is responsible for
lengthwise growth of a long bone

111. Describe sciatic nerve under following headings

a. Origin and root value
b. Course and relations
c. Branches
(1+3+1=5 marks)
a) Origin: terminal branch of lumbosacral plexus
b) Course:
 Arises in the pelvis and leaves the pelvis by passing through greater sciatic foramen
below the piriformis to enter gluteal region
 In gluteal region it lies deep to gluteus maximus and crosses superior gamellus,
obturator internus, inferior gamellus and quadratus femoris to enter back of thigh
 In gluteal region it lies between ischial tuberosity and greater trochanter
 In the back of thigh it lies deep to biceps femoris and superficial to adductor magnus
Relations:
 In pelvis : lies in front of piriformis
 In gluteal region:
-superficial/posterior: glutes maximus
-deep/anterior: Body of ischium
Tendon of obturator internus with gamelli
Quadratus femoris, obturator externus
Capsule of hip joint
 In the thigh:
-posterior: crossed by long hesd of biceps femoris
-anterior: adductor magnus
-lateral: biceps femoris
-medial: semitendinosus, semimembranosus
c) Branches:
Branches:
From tibial component From peroneal component
Muscular Long head of biceps femoris, Short head of biceps
semitendinosus, semimembranosus, femoris

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 ischial part of adductor magnus
Articular Hip joint -
Terminal Tibial & common peroneal nerve -

112. A foot ball player collided with another player while playing and fell on to the
ground. As he fell, the right knee, which was taking the weight of the body, was
partially flexed and the femur was rotated medially, and the leg was abducted on
the thigh. A sudden pain is felt on the knee joint and he was unable to extend it.
The rupture of an intra-articular structure of the knee joint was diagnosed. With
your knowledge of Anatomy:

a. Name the structure ruptured and give its attachments.

b. Name the intra-articular structures of the knee joint.
c. Describe the locking mechanism of the knee joint.
(2+1+2=5 marks)
a) Medial meniscus
For other parts of the answer, please refer to the previous answers

Durga & Sathis

113. Name the muscles of the anterior compartment of the leg and mention their actions
and nerve supply.
(3 marks)
MUSCLES NERVE SUPPLY ACTIONS
Tibialis Deep peroneal nerve  Dorsiflexor of foot
anterior  Inverter of foot
 Maintains medial longitudinal arch
Extensor Deep peroneal nerve  Dorsiflxor of foot
hallucis longus  Extensor of metatarsophalangeal
and interphalangeal joint
Extensor Deep peroneal nerve  Dorsiflexor of foot
digitorum  Extends metatarsophalangeal,
longus proximal and distal interphalangeal
joints of 2nd-5th toes
Perones tertius Deep peroneal nerve  Dorsiflexor of foot
 Evertor of foot
Extensor Lateral terminal  Medial tendon known as extensor
digitorum branch of deep hallucis brevis, extends
brevis peroneal nerve metatarsophalangeal joint of big
toe
 Other 3 lateral tendons extend
metatarsophalangeal and
interphalangeal joint of 2nd. 3rd and
4th toes

114. Name the bones forming and structures maintaining the medial longitudinal
arch.
(2 marks)
Please refer the previous answers

Durga & Sathis

115. Describe the formation and fate of corpus luteum.
(2+1=3 marks)
 Please refer the previous answers

116. Discuss the formation of chorionic villi.

(3 marks)
 Please refer the previous answers

117. Explain the formation of neural tube and its congenital anomalies.
(3+1=4 marks)
Formation:
 Ectoderm overlying notochord thickens to form neural plate by the process of
neurulation and the cells are called neurectoderm
 Lateral edges of neural plateform folds called neural fold
 Depression between the folds a called neural groove
 Gradually the folds approach each other and meet at midline
 Fusion begins at cervical region and proceeds cranially and caudally
 The fusion of neural folds form neural tube which at the beginning has 2
opening at its 2 ends
 Cranial opening is called cranial neuropore and caudal opening is called
caudal neuropore
 Cranial neuropore closes on 25th day and caudal neuropore closes at 27th day
Congenital anomalies:
 Anencephaly
-neural tube fails to close in cranial region so most of the parts of the brain fail to
develop
 Spina bifida
-neural tube fails to close anywhere from the cervical region caudally

118. Draw a labelled diagram of microscopic structure of transverse section of bone.

(5 marks)
Please refer the previous answers

Durga & Sathis

119. With a labelled diagram, explain the histology of spleen.
(5 marks)
 Please refer the previous answers

120. With a labeled diagram, explain the microscopic structure of stratified squamous
keratinized epithelium.
(4 marks)

Stratified squamous keratinized epithelium:

 Superficial to deep, it has the following strata
o Stratum corneum
o Stratum lucidum
o Stratum granulosum
o Stratum spinosum
o Stratum basale
 Stratum corneum: Most superficial layer. Has cells filled with keratin. These cells do
not have nucleus
 Stratum lucidum: The cells in this layers contain refractive eleidin granules
 Stratum granulosum: Has a few layers of diamond shaped cells filled with
keratohyalin granules
 Stratum spinosum: Has polygonal cells with a prickly appearance. This strata has two
to three layer of cells
 Stratum basale: The deepest layer resting on the basement membrane. It consists of
single layer of columnar or cuboidal cells. This layer also consists of pigment cells
 This epithelium is found in the skin

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 121. a. Classify the bones based on its development giving one example for each.
b. Name the parts of an adult long bone. Add a note on its blood supply
(1+1+3=5 marks)
a)
DEVELOPEMENTAL CLASSIFICATION EXAMPLE
Membrane bones (dermal bones) Facial bones, bones of vault of skull
Cartilaginous bones Thoracic cage, limb bones
Membrano-cartilagenous bones Clavicle, mandible, occipital bone
Somatic bones Vertebrae

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 Visceral bones Hyoid bone, mandible, ossicles

b) Parts of adult long bone:

 shaft which consist of:
 periosteum
 cortex
 medullary cavity
 2 ends

Blood supply of long bones:

 Nutrient artery:- enters shaft through nutrient foramen and divides in to ascending and
descending branch in medullary cavity
-supplies medullary cavity, inner 2/3 of cortex and metaphysis
 Periosteal arteries: -Lie beneath muscular and ligament attachments
-ramify beneath periosteum and enter Volkmann’s canal to supply

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 Outer 1/3 of the cortex
 Epiphysial artery: -derived from periarticular vascular arcades(circulus vasculosus)
Found on the nonarticular bony surfaces
 Metaphysial artery: -derived from neighbouring systemic vessels
-pass directly into metaphysis and reinforce metaphysial
branches from primary nutrient artery

122. Give origin, insertion and nerve supply of popliteus. Add a note on unlocking
mechanism of the knee joint
(3+2=5 marks)
ORIGIN  From the popliteal groove on the lateral surface of
lateral condyle of femur
INSERTION  Posterior surface of shaft of tibia above soleal line
NERVE SUPPLY  Tibial nerve

Unlocking: - Please check the previous answers

123. Mention the muscles producing supination of the forearm. Explain the origin,
insertion and nerve supply of any one of them.
(1+3=4 marks)
Muscles:
 Biceps bracii
 Supinator

 Biceps brachii

Origin: long head originates fromsupraglenoid tubercle of scapula

short head originates from the corocoid process of scapula

Insertion: posterior rough part of radial tuberosity

nerve supply: musculocutaneous nerve

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124. A 10 year old boy fell on the outstretched hand and taken to orthopaedic
department. His X-ray showed supracondylar fracture of humerus with forward
displacement of distal fragment. On examination, his radial pulse was weaker,
compared to the opposite side;
a. Give reason for the weaker radial pulse
b. Give the origin, course, termination and branches of the structure damaged
(1+4=5 marks)
a) This is due to the injury of the brachial artery which gives radial artery as one of its
terminal branches

b)
 Continuaton of axillary artery from the lower border of teres
ORIGIN
major
 Runs downward and laterally in front of arm and crosses elbow
COURSE
joint
 End at level of neck of radius in cubital fossa by dividing into
TERMINATION
radial and ulnar artery
 Muscular
 Profunda brachii artery
 Superior ulnar collateral
BRANCHES
 Nutrient artery
 Inferior ulnar collateral
 Radial and ulnar artery

125. Write a note on carpal tunnel. What is carpal tunnel syndrome?

(4+1=5 marks)
Carpal tunnel:
 It is the space under the flexor retinaculum of the wrist. Flexor retinaculum of wrist
bridges the anterior concavity of carpus and turns it into a tunnel known as carpal
tunnel
Boundaries:
 Anterior: flexor retinaculum
 Posterior: concave anterior surface of carpus formed by carpal bones and intercarpal
ligaments

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 Contents : structures passing through carpal tunnel include the following

1. Median nerve
2. 4 tendons of flexor digitorum superficialis
3. 4 tendons of flexor digitorum profundus
4. Tendon of flexor pollicis longus
5. Ulnar bursa
6. Radial bursa
7. Tendon of flexor carpi radialis (passes through a separate compartment of flexor
retinaculum)

Carpal tunnel syndrome:

 Results due to compression of median nerve at carpal tunnel

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  Characterized by: wasting of thenar eminence(ape-like thumb), hypoaesthesia to
light touch on the palmar aspect of lateral 3 and a half digits. Characteristic pain
called “pins and needles” in the lateral part of the hand and lateral 3 and half
digits.
 The skin over thenar eminence is not affected as the branch of median nerve
supplying I arises in the forearm.

126. Name the muscles attached to the acromion process of scapula and mention their
nerve supply
(1+1=2 marks)
MUSCLES NERVE SUPPLY
Trapezius Spinal part of accessory nerve
Deltoid Axillary nerve

127. Write a note on ankle joint under the following headings:

a. Type and subtype
b. Articular surfaces
c. Ligaments
d. Movements
(1+1+2+1=5 marks)
a) Type: synovial subtype: hinge
b) Articular suface:
UPPER ARTICULAR SURFACE LOWER ARTICULAR SURFACE
 Lower part of tibia including medial  Articular areas on upper, medial and
malleolus lateral aspect of talus
 Lateral malleolus of fibula
 Inferior transverse tibiofibular
ligament

c) Ligaments:

 Fibrous capsule: surrounds the joint and is attached all around articular margins
except:
a) posterosuperiorly, where it is attached to transverse tibiofibular ligament
b) anteroinferiorly, where it is attached to dorsum of neck of talus

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  Deltoid/medial ligament: strong triangular ligament on medial side of ankle
 Lateral ligament: consist of following parts
a) anterior tibiofibular ligament
b) posterior tibiofibular ligament
c) calcaneofibular ligament

d) Movements:

MOVEMENT MUSCLES

 Tibialis anterior
 Extensor halluces longus
Dorsiflexion
 Extensor digitorum longus
 Peroneus tertius

 Gastrocnemius
 Soleus
Plantar flexion  Flexor halluces longus
 Flexor digitorum longus
 Tibialis posterior

128. A patient presented with loss of skin sensation on medial aspect of leg and medial
margin of dorsum of the foot. He was unable to extend the knee actively. With your
anatomy knowledge
a. Give the name, root value and termination of the nerve involved.
b. Give reasons for:
i. Loss of sensation
ii. Loss of ability to extend the knee
(3+2=5 marks)
a)

NAME Femoral nerve

ROOT VALUE Dorsal division of anterior primary rami of spinal nerves L2, L3 and L4

TERMINATION Ends by dividing into anterior and posterior divisions

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 b)

It gives a branch, saphenous nerve which supplies skin on medial aspect of leg. So injury
to femoral nerve results in the abovesaid loss of skin sensation

It supplies muscles of anterior compartment which are quadriceps femoris that extends
the knee. Hence power of extension of knee is lost in case of injury to femoral nerve

129. Write a note on adductor canal

(4 marks)
 Also known as subsartorial canal or Hunter’s canal
 Intermuscular space situated on the medial side of middle 1/3 of thigh
 Extent: from apex of femoral triangle above to the tendinous opening in adductor
magnus below
 Boundaries :
 Anterior wall: vastus medialis
 Posterior wall: adductor longus (above), adductor magnus (below)
 Medialwall (roof) : strong fibrous membrane joining anterior and posterior
wall-overlapped by Sartorius
 Contents:
 Femoral artery
 Femoral vein
 Saphenous nerve
 Nerve to vastus medialis
 2 divisions of obturator nerve

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130. Describe the formation and fate of the neural crest cells
(1+4=5 marks)
 Please refer the pervious answers

131. A female infant was born with a large tumor situated between the rectum and
sacrum. A diagnosis of sacrococcygeal teratoma was made and the mass was
surgically removed.
a. What is the probable embryological origin of the tumor and name the specific
period when the embryological structure originates.
b. Describe the process involved in the formation of trilaminar germ disc.
(2+3=5 marks)
a) Origin: remnants of primitive streak
Period: 3rd week of gestation

b) Gastrulation
 It is a process by which the 3 germ layers are formed by the epiblast cells
 In 3rd week of IUL, a faint groove appear at caudal end of embryonic disc known as
primitive streak
 Primitive streak lies cranial to proctodeal plate and ends cranially as primitive node or
primitive pit
 Cells of epiblast divide mitotically and move in the direction of primitive streak and
upon reaching it, they slide down between cells of primitive streak through a process
of invagination
 The invaginating cells displace the hypoblast cell to form embryonic endoderm
 Cells between newly formed endoderm and epiblast are called intraembryonic
mesoderm
 The remaining cells of epiblast are called ectodermcels of intraembryonic mesoderm
migrate all over between ectoderm and endoderm except at prechordal plate and
proctodeal plate where ectoderm is tightly attached to endoderm
 Prechordal plate forms buccopharyngeal membrane and proctodeal plate forms
cloacal membrane

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132. Describe the blastocyst under the following headings:
a. Formation
b. Parts, with the help of a diagram
c. Changes happening to it in the second week of development
(1+1+4=6 marks)
a) Formation:
 When the morula enters uterine cavity, fluid secreted by uterine cavity enters morula
and causes formation of a cavity in the morula known as blastocele
 After the cavity is formed, the morula is known as blastocyst
b) Parts:

c) Changes in 2nd week:

 changes are seen both in embryoblast and tropoblast
 the blastocyst gets completely embedded in the endometrium
 extraembryonic mesoderm and extraembryonic coelom are also formed
 changes in tropoblast :- it differentiates into outer syncytiotropoblast and
inner cytotropoblast
-chorionic villi are formed
 embryoblast differentiates into epiblast and hypoblast

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133. Write a short note on blood supply of long bone
(3 marks)
Please refer the previous answers

134. Describe the lymphatic drainage of mammary gland and give its clinical
importance.
(4 marks)
75% of the lymph drains into axillary nodes
20% drains into internal thoracic nodes
5% drains into posterior intercostal nodes

Breast can be divided into four quadrants. Lymph from the upper and lower lateral quadrants
drains mainly into axillary (anterior group) lymph nodes. Lymph from the upper and lower
medial quadrants passes mainly to the internal thoracic nodes.
In addition to these nodes, minor quantity also goes to supraclavicular and cephalic nodes.
Lymph vessels of the breast are divided into superficial and deep groups. Superficial group
drain the skin except the areola and nipple. Deep lymph vessels drain the parenchyma, nipple
and areola. A small plexus lies deep to areola and it is called Sappy's plexus. Lymphatics
from the lower medial quadrant of the breast communicate with the subdiaphragmatic and
subperitoneal lymphatics.
Clinical importance:
 Communication of superficial lymphatics of breast across the midline allows cancer
to spread from one breast to another
 Due to communication of lymph vessels with those in abdomen, cancer may spread to
liver and cancer cells may drop into pelvis producing secondaries there

135. Write a brief note on the axillary artery and its branches?
(5 marks)
Please refer the previous answers

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136. Explain a typical synovial joint and give its classification.
(4 marks)
Please refer the previous answers
137. Explain briefly about the medial longitudinal arch of the foot?

Please refer the previous answers

138. Describe the boundaries of femoral triangle and enumerate its contents.
(4+4=8 marks)

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Boundaries:
LATERAL  Medial border of sartorius

MEDIAL  Medial border of adductor longus

BASE  Inguinal ligament

APEX  Point where medial and lateral boundaries meet

 Skin
 Superficial fascia containing superficial inguinal lymph
ROOF node, femoral branch of genitofemoral nerve
 Deep fascia with saphenous opening and cribriform
fascia

 Medially: adductor longus and pectineus

FLOOR
 Laterally: psoas major and iliacus

Contents:
 Femoral artery
 Femoral vein
 Femoral nerve
 Nerve to pectineus
 Femoral branch of genitofemoral nerve
 Lateral cutaneous nerve of thigh
 Deep inguinal lymph nodes

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139. Following a severe automobile accident, a 25 year old woman was found to have an
unstable knee joint. On examination under an anaesthetic, it was possible to pull
the tibia forward excessively on the femur.
a. What structure was damaged in the knee joint?
b. What are its attachments?
c. List the movements possible at the knee joint and mention the muscles
producing each of these movements.
(1+2+4=7 marks)
a) Anterior cruciate ligament
Please refer the previous answers for b and c

140. Discuss about the subsartorial canal and mention its clinical importance.
(3+2=5 marks)
Please refer answer of question 129.

141. Describe the spermatogenesis and list the differences between spermatogenesis and
oogenesis.
(4+2=6 marks)
Spermatogenesis:
It is the process by which the spermatogonia are transformed into spermatozoa. The process
needs approximately 64 days. At the time of birth, the testis contains primordial germ cells.
These primordial germ cells are endodermal cells from the yolk sac which migrate into the
developing testis. Till puberty, the seminiferous tubules are represented as 'sex cords' in the
testis. Shortly before puberty, the sex cords acquire lumen and become seminiferous tubules.
At the same time, the primordial germ cells give rise to spermatogonia.
The process of spermatogenesis has two stages; the first one is called spermatocytosis and the
second one is called spermiogenesis.

Spermatocytosis:
This is the process by which the spermatogonia divide to produce spermatids. Spermatogonia
are of two types, 'Type A' and 'Type B'
Type A spermatogonia divide mitotically to provide a continuous reserve of stem cells where
as the type B spermatogonia divide mitotically to produce primary spermatocytes. The
primary spermatocytes, through first meiotic division, produce secondary spermatocytes. The

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secondary spermatocytes divide again (second meiotic division) to produce spermatids.

Spermiogenesis (spermateliosis):

This is the process by which the spermatid is transformed into a spermatozoon by

morphological changes. This process does not include any division.
The events of formation of spermatozoon from spermatid:
1. Condensation of the nucleus
2. Formation of 'acrosomal cap' by golgi apparatus
3. Formation of neck, middle piece and tail
4. Shedding of most of the cytoplasm
5. Formation of mitochondrial sheath

The spermatozoa, when formed are slightly motile. They are pushed towards the epididymis
by contractile elements in the wall of seminiferous tubules. Then the spermatozoa get their
full motility in the epididymis.
Differences:
FEATURES SPERMATOGENESIS OOGENESIS
Site Seminiferous tubule of testis Cortex of ovary
Onset After puberty Before birth
Number of gametes formed 4 sperms from one 1 secondary oocyte from one
spermatogoneum oogonium

142. Name the structure that secretes progesterone. Discuss the formation and fate of it.
(1+2+1=4 marks)
Corpus luteum
 Please refer the previous answers

143. Draw the labeled diagram of the microscopic anatomy of hyaline cartilage and list
the examples of it.
(2+1=3 marks)
Please refer the previous answers. Hyaline cartilage is found in the walls of nose, thoracic
cage, larynx, articular surfaces of synovial joints, auditory tube, external acoustic meatus etc

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144. Explain the structure of urothelium with the help of a diagram.
(3 marks)

Urothelium:
 It is also known as transitional epithelium
 It is 4-6 layers thick
 Basal cells are approximately cuboidal
 Intermediate layers are pear shaped cells called Piriform cells
 Surface cells are sometimes binucleated
 This epithelium is known for its stretchability and impermeability
 It neither secretes nor absorbs

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145. A 6 years old boy was suffering from high fever. At the hospital, a nurse gave him
an intramuscular injection into his right upper limb. Few days after injection the
boy noticed that he could not abduct his right upper limb. Name the structure that
is damaged and describe its course and distribution.
(2+1+3=6 marks)
NERVE Axillary nerve
 Passes through lower part of axilla and enters quadrangular
COURSE
space where it terminates by dividing into 2 branches
 Trunk
 Articular branch: to shoulder joint
 Anterior division
 Muscular branch: to deltoid
 Posterior division
DISTRIBUTION
 Muscular: to deltoid and teres minor. The branch to
teres minor bears a pseudoganglion
 Cutaneous : upper lateral cutaneous nrve of forearm
which supplies skin over the deltoid
 Vascular : to posterior circumflex humeral artery

146. Classify the primary tissues of the body. Enumerate the cells of the general
connective tissue. List the differences between the connective tissue fibres.
(1+2+2=5 marks)

Primary tissues:
1. Epithelial tissue
2. Connective tissue
3. Muscle tissue
4. Nervous tissue

Cells of general connective tissue:

 Fibroblast
 Macrophage
 Mast cells

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  Plasma cells
 Adipose/Fat cell
 Pigment cells
 Mesenchyme cells

Connective tissue fibres

Collagen fiber Elastic fiber Reticular fiber

Arrangement of Run in wavy bundles Run singly Forming a network
fibers
Staining Acidophilic Orcein Argyrophilic
Branching Individual fibres are not Individual fibres Individual fibres are
property branched are branched branched
When heated Dissociate to form gelatin Do not change Do not change
Occurance In all connective tissues, In ligamentum Form skeleton of
cartilages, bones, tendons nuchae, lymphoid organ &
& aponeuroses ligamentum endocrine gland
flavum, blood
vessel

147. Write a note on somite.

(5 marks)
 Please refer the previous answers

148. Give the extent, relations (to the brachial plexus only) and branches of the axillary
artery.
(½+3+1½=5 marks)
Extent: from outer border of the 1st rib to the lower border of teres major

Relation:
 1st part
-laterally: lateral cord and posterior cord
-posteriorly: medial cord

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  2nd part
-laterally: lateral cord
-medially: medial cord
-posteriorly: posterior cord
 3rd part
-laterally: musculocutaneous nerve (upper part), median nerve (lower part)
-medially: medial cutaneous nerve of forearm, ulnar nerve, axillary vein, medial
cutaneous nerve of arm
-posteriorly: axillary nerve (upper part) , radial nerve (lower part)

Branches:
 1st part : superior thoracic artery
 2nd part: thoracoacromial artery , lateral thoracic artery
 3rd part : subscapular artery, anterior circumflex humeral artery , posterior circumflex
humeral artery

149. A 35 year old man was seen in the emergency room with the inferior dislocation of
the shoulder joint. Even after the correction of the dislocation, the patient was
unable to abduct his shoulder and had anaesthesia over the lower half of the
deltoid muscle. The senior doctor said a branch of the brachial plexus had been
injured during the dislocation.
a. Name the nerve injured during the dislocation.
b. Give its root value, course and distribution.
c. Name the muscle responsible for the loss of abduction at the shoulder.
(1+3+1=5 marks)
a) Axillary nerve
b)
ROOT VALUE  Anterior primary rami C5 and C6
segment of spinal nerve
COURSE  Passes through lower part of axilla
and enters quadrangular space where
it terminates by dividing into 2
branches
DISTRIBUTION  Trunk

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  Articular branch: shoulder
joint
 Anterior division
 Muscular: deltoid
 Posterior division
 Muscular: deltoid and teres
minor
 Cutaneous : upper lateral
cutaneous nrve of forearm
 Vascular : posterior
circumflex humeral artery

c) Deltoid muscle

150. Mention the boundaries and contents of the carpal tunnel. What is carpal tunnel
syndrome ?
(1+2+2=5 marks)
Boundaries:
Please refer the previous answers

151. Give the attachments, nerve supply and actions of trapezius muscle.
(2+1+2=5 marks)
Trapezius muscle:
 Medial 1/3 of superior nuchal line
ORIGIN  External occipital protuberance
 Ligamentum nuchae
 Upper fibres: posterior border of lateral 1/3 of clavicle
 Middles fibres: medial margin of acromion and upper lip
INSERTION
of crest of spine of scapula
 Lower fibres: deltoid tubercle at medial end of spine
Motor: spinal part of accessory nerve
NERVE SUPPLY
Proprioceptive: C3, C4
 Upper fibres elevate scapula with levator scapulae
ACTIONS
 Middle fibres retract scapula with rhomboideus

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  Steadies scapula
 Upper and lower fibres involved in abduction beyond
90◦

152. Describe the bones forming and the structures maintaining the medial longitudinal
arch of the foot. What are the functions of the arches of the foot?
(2+2+1=5 marks)
 Please refer the previous answers
Functions of arches of foot:
 Provide a lever mechanism for fast walking, running and jumping
 Help in weight bearing by giving a spring action
 Help in maintaining upright posture

153. Describe the bones forming and the structures maintaining the medial longitudinal
arch of the foot. What are the functions of the arches of the foot ?
(2+2+1=5 marks)
Please refer the previous answers

154. Give an account of the origin and root value, deep (anterior) relations and
branches of sciatic nerve.
(1+2+2=5 marks)
Origin: terminal branch of lumbosacral plexus
Root value: ventral rami of L4, L5, S1, S2, S3
Deep/Anterior relations: superior gemellus, obturator internus, inferior gemellus,
quadratus femoris

Branches: Please refer the previous answers

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155. A 27 year old woman was found to have an unstable right knee joint following a
severe automobile accident. On examination, it was possible to pull the tibia
excessively forward on the femur. The doctor said that it was due to the rupture of
an intra-articular structure.
a. Name the structure ruptured and give its attachments.
b. Mention the other intra-articular structures of the knee joint.
c. Describe the locking mechanism of the knee joint.
(1½+1½+2=5 marks)

a. Anterior cruciate ligament

b. Please refer the previous answers
c. Please refer the previous answers

156. Describe the attachments, nerve supply, openings and actions of adductor magnus
muscle.
(2+1+1+1=5 marks)
Origin: a) inferolateral part of ischial tuberosity
b) Ramus of ischium
c) Lower part of inferior ramus if pubis

Insertion: a) Medial margin of gluteal tuberosity

b) Linea aspara
c) Medial supracondylar line
d) Adductor tubercle

Nerve supply:
Adductor part: by posterior division of obturator nerve
Hamstring/ischial part: by tibial part of sciatic nerve

Openings: hiatus magnus (the femoral artery becomes popliteal artery after pass
through this opening)
Actions:
Adductor part: adduction of thigh
Hamstring/ischial part: extension of hip and flexion of knee

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157. Classify the primary tissues of the body. Enumerate the cells of the general
connective tissue. List the differences between the connective tissue fibres.
(1+2+2=5 marks)
Please refer the previous answers

158. Classify the synovial joints based on the shape of articular surfaces giving one
example for each.
(3½ marks)
Please refer the previous answers

159. a. Classify synovial joints giving one example for each.

b. Discuss the factors upon which the stability of a joint is dependent.
(7+3=10 marks)

Please refer the previous answers

160. Classify the joints, giving suitable examples for each type and subtype.
(5 marks)
a) Fibrous joints:
-sutures: between bones of skull
-syndesmosis: inferior tibiofibular joint
-gomphosis: root of tooth in its bony socket

b) Cartilaginous joints:
-primary cartilaginous (synchondrosis): costochondral joints
-secondary cartilaginous (symphysis): symphysis pubis

c) Synovial
SUBTYPE EXAMPLE
Ball and socket Hip joint
(spheroidal)
Saddle (sellar) Sternoclavicular
Condylar Temporomandibular

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 Ellipsoid Wrist joint
Hinge Elbow joint
Pivot / trochoid Superior and inferior
radioulnar
Plane Sacroiliac joint

161. Draw and label the parts of a typical synovial joint.

(5 marks)

Please refer the previous answers

162. Name the joints of lower limb. Mention the type and subtype of each of them.
(5 marks)
Please refer the previous answers

163. Classify the bones based on shape and size giving one example for each.
(2½ marks)

 Please refer the previous answers

164. Mention the parts of a growing long bone.

(2 marks)

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165. Classify the bones based on their shape, size and consistency giving one example
for each.
(1½+1½=3 marks)
 Please refer the previous answers

166. Explain the formation and termination of a spinal nerve with the help of a labelled
diagram.
(3 marks)

Each spinal nerve is connected with the spinal cord by 2 roots, a ventral root (motor) and a
dorsal root (sensory). The dorsal root is characterized by presence of a spinal ganglion. The
ventral and dorsal nerve roots units together within the intervertebral foramen to form the
spinal nerve. The nerve emerges through the intervertebral foramen gives off recurrent
meningeal branches, and then divides into a dorsal and ventral rami. The dorsal ramus passes
backwards and supplies the intrinsic muscles of the back and skin covering them. The ventral
ramus is connected with the sympathetic ganglion, and is distributed to the limb or the
anterolateral body wall.

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167. Draw and label the parts of a typical spinal nerve.
(5 marks)

168. With a labeled diagram explain the microscopic structure of medium sized artery.
(3 marks)
 It is also called muscular artery
 Tunica intima – consists of a layer of endothelial cells lining the lumen of vessel & a
wavy elastic lamina (internal elastic lamina)
 Tunica media – tthickest of the 3 coats, contains plain muscle & elastic fibres
 Tunica externa/adventitia – contain areolar tissue with a few elastic fibres

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169. With the help of a diagram describe the transverse section of a compact bone.
(5 marks)
Please refer the previous answers

170. Explain the micro-structure of hyaline cartilage.

(5 marks)
Please refer the previous answers

171. Classify epithelia and mention one site each where each of the class is found.
(6 marks)
Please refer the previous answers

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172. With the help of a labelled diagram explain the microscopic features of a large
(elastic) artery.
(4 marks)

 Absence of internal elastic lamina

 Tunica intima – consist of a layer of endothelial cells lining the lumen of vessel
 There is a layer of subendothelial connective tissue
 Tunica media considerably thickened & contains abundant elastic and few plain
muscle fibers
 Elastic fibres form fenestrated laminae in the tunica media
 Tunica externa – contain some areolar connective tissue in which there are few blood
vessels (vasa vasorum)

173. Explain the microanatomy of a spinal ganglion with the help of a diagram.
(4 marks)
 Has a thick capsule
 Has pseudounipolar neurons arranged in the groups
 The cell bodies of neurons have centrally placed nucleus
 Very few lood vessels are seein
 Regularly arranged nerve fibres (in bundles) entering and leaving the ganglion
 Satellite cells surround the cell body of neurons

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174. Write a note on skeletal muscle
(5 marks)
Skeletal muscle is also known as somatic muscle/striated muscle/striped muscle/voluntary
muscle.

Present in limbs, body wall, tongue, pharynx,

Occurance
& beginning of esophagus
Shape & size Long & cylindrical
Fibers Unbranched

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 Nucleus Multinucleated (Peripheral nucleus)
Bounded by Sarcolemma
Bands present Light & dark
Intercalated disk No
Nerve supply From somatic nervous system
Blood supply Abundant
Contraction Very rapid
After contraction Soon gets fatigued
Nature Voluntary

Durga & Sathis

175. Define the following terms:
a. Antagonists
b. Ganglion
c. Bursa
d. Epiphysis
e. Sesamoid bone
f. Anastomosis
(6 marks)
a) Antagonists are the muscles that oppose the prime movers (agonist). Help the agonist
by active controlled relaxation, so that desired movement is smooth & precise.
b) Ganglion is a cystic swelling resulting from mucoid degeneration of synovial sheath
around the tendons. In the peripheral nervous system, ganglion is a collection of cell
bodies of neurons.
c) Bursa is a synovial fluid filled bag in relation to joints & bones, to prevent friction.
The inflammation of bursa is called the bursitis.
d) Epiphysis is the end & tip of a bone which ossify from secondary centres.
e) Sesamoid bone is a bony nodule found embedded in tendons or joint capsules. It does
not have periosteum and medullary cavity & it ossifies after birth.
f) Anastomosis is a precapillary or postcapillary communication between neighbouring
vessels

176. Name the cells of the loose ordinary connective tissue. Write briefly about each of
them.
(1½+3=4½ marks)
1. Fibroblasts: synthesize and secrete collagen and other fibres
Surface view – large, flat and branching cells
Profile – fusiform/spindle shaped
Cell membrane – not well defined
Cytoplasm – pinkish in colour
Nucleus – large, oval/rounded, centrally placed & lightly stained
2. Macrophages: pleomorphic cells
Ovoid, irregular with short processes
Cytoplasm – granular & vacuolated
Nucleus – small, round, deeply stained

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 Function – phagocytic
Giant cells – in pathological condition a number of these cells unite to form a single
multinucleated giant cell.

3. Mast cells: large cells, rounded/oval

Cytoplasm- coarsely granular
Nucleus- small
Function- produces heparin (an anticoagulant), histamine inder allergic condition,
serotonin (vasoconstrictor)

4. Plasma cells: oval/round cells,

chromatin shows cart-wheel appearance
Nucleus – small & eccentric
Function- defence mechanism & produce antibodies
Mostly found under wet epithelium \-mucous membrane of alimentary canal

177. Give the extent, relations (to the brachial plexus only) and branches of the axillary
artery.
(½+3+1½=5 marks)
Please refer the previous answers

178. Mention the beginning, course, termination and branches of axillary artery. Add a
note on relations of cords of brachial plexus to it.
(1+½+1+1½+1=5 marks)
Please refer the previous answers

179. Give the origin, course, termination and branches of the radial artery.
(4 marks)
Origin: smaller terminal branch of brachial artery in the cubital fossa, at the level of neck of
the radius

Course: - runs downwards to wrist with a lateral convexity, turn posteriorly by passing deep
to tendon of abductor pollicis longus, the extensor pollicis brevis & extensor pollicis longus
& superficial to lateral ligament of wrist joint.

Durga & Sathis

-passes through anatomical snuff box to reach proximal end of 1st interosseous space
-passes between 2 heads of 1st dorsal interosseous muscle & between 2 heads of abductor
pollicis & forms deep palmar arch in the palm (Termination)

Branches:
In the forearm:
1. Radial recurrent artery
2. Muscular branches
3. Palmar carpal branch
4. Superficial palmar branch
In the dorsum of hand:
1. Branch to lateral side of dorsum of thumb
2. 1st dorsal metacarpal artery
In the palm:
1. Princeps pollicis artery
2. Radialis indices artery

180. Mention the boundaries and contents of the carpal tunnel. What is carpal tunnel
syndrome?
(1+2+2=5 marks)
Please refer the previous answers

181. Give the attachments, nerve supply and actions of trapezius muscle.
(2+1+2=5 marks)
Please refer the previous answers
182. Describe the extent, course, branches and anterior relations of the brachial artery.
(5 marks)
Please refer the previous answers

183. Give the formation, relations and branches of the superficial palmar arch.
(1+1½+½=3 marks)
Please refer the previous answers

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184. Describe the median cubital vein and its clinical importance.
(2+1=3 marks)

 A large communicating vein which shunts blood from cephalic to basilic vein
 Begins from cephalic vein below bend of elbow, runs obliquely upwards &
medially & ends in basilic vein above medial epicondyle
 It is separated from brachial artery by bicipital aponeurosis
 May receive tributaries from front of forearm (median vein of forearm)
 Connected to deep veins through perforator vein which pierces bicipital
aponeurosis. This perforator vein fixes the median cubital vein & thus make it
ideal for intravenous injections
 Median cubital vein is the vein of choice for intravenous injection.
 Median cubital vein can be used to draw a sample of venous blood

185. Describe the cephalic vein under the following headings:

a. Beginning
b. Termination
c. Course
(½+½+2=3 marks)
Beginning: begins from lateral end of dorsal venous arch
Course: It runs upwards :
a) Through roof of anatomical snuff box
b) Winds around lateral border of distal part of forearm

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 c) In front of elbow & along lateral border of biceps brachii
d) Pierces deep fascia at lower border of pectoralis major
e) Runs in deltopectoral groove upto infraclavicular fossa
f) Pierces clavipectoral fascia & joins axillary vein
Termination: it terminates by joining the axillary vein

186. Mention the origin, root value, course and distribution of axillary nerve. What are
the effects of injury to this nerve?
(1+1+1+2+2=7 marks)
Please refer the previous answers

187. Give an account of the origin, root value, course and branches of the radial nerve.
What happens when the nerve is injured in the axilla?
(½+½+1½+1½+1=5 marks)
Please refer the previous answers

188. What is nerve related to the spiral groove of humerus? Describe its distribution in
arm.
(½+1½=2 marks)
Radial nerve
Distribution in arm:
Please refer the previous answers

189. Name the branches of posterior cord of the brachial plexus.

(2½ marks)
1. Upper subscapular (C5,C6)
2. Lower subscapular(C5,C6)
3. Thoracodorsal/nerve to latissimus dorsi (C6,C7,C8)
4. Radial(C5-C8,T1)
5. Axillary(C5,C6)
190. Name the muscles supplied by median nerve in the palm.
(2½ marks)
1. 1st & 2nd lumbricals
2. Abductor pollicis brevis

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 3. Flexor pollicis brevis
4. Opponens pollicis
191. Give the origin, course and distribution of the anterior interosseous nerve.
(½+1+1½=3 marks)
Origin: It is a muscular branch of median nerve given off in upper part of forearm
Course: It runs down in the anterior compartment of the forearm close to the interosseous
membrane, accompanied by the anterior interosseous artery
Distribution: it supplies flexor pollicis longus, lateral half of flexor digitorum profundus &
pronator qudratus. It also supplies distal radioulnar & wrist joints.

192. What is Erb's point? What are the consequences of injury at this point?
(1+3=4 marks)
Erb’s point is a region of the upper trunk where the following 6 nerves meet
A. C5 root
B. C6 root
C.
D. Anterior division of upper trunk
E. Posterior division of upper trunk
F. Suprascapular nerve
G. Nerve to subclavius

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Injury to this point causes: policeman’s tip hand/ porter’s tip hand
Arm: to hangs by the side; it is adducted & medially rotated
Forearm: extended & pronated
Disability: following movements are lost;
a) Abduction & lateral rotation of the arm
b) Flexion & supination of the forearm
c) Biceps & supinator jerks are lost
d) Sensations are lost over a small area over the lower part of deltoid

193. Explain the cutaneous innervation of hand.

(5 marks)

Median nerve gives off 2 sets of cutaneous branches in the hand:

1. Palmar cutaneous branch ( arise short distance above wrist, superficial to flexor
retinaculum)- supplies skin over the lateral 2/3 of palm including that over thenar
eminence
2. Palmar digital branches (5 in number and arises in palm) – supply palmar skin of the
lateral 3 and a half digits, the nail beds, and skin on the dorsal aspect of middle and
distal phalanges of the same digits.
Ulnar nerve gives off 3 sets of cutaneous branches in the hand:
1. Palmar cutaneous branch (arises in middle of forearm) – supplies skin of the medial
1/3 of palm

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 2. Palmar digital branches (2 in number & arise from superficial terminal branch of
ulnar nerve)
3. Dorsal branch of ulnar nerve (arises about 5 cm above the wrist)- supplies medial
half of the back of the hand and the medial one and a half fingers

Superficial terminal branch of the radial nerve (arises in front of the lateral epicondyle of
humerus) – supplies skin of the lateral half of the dorsum of the hand & dorsal surfaces of the
lateral three and a half digits including thumb except the terminal portions which are supplied
by median nerve

194. A young man sprained his ankle while playing a football match. His ankle was
immobilised and was asked to use crutches for three weeks. Following this, he
developed weakness in the muscles of back of the forearm. He had difficulty in
extending the wrist joint.
a. What is the probable cause for this?
b. Mention the innervation of the muscles of the posterior compartment of the
forearm.
c. Name the muscles of extensor compartment of the forearm which are not
acting on the wrist joint.
(4 marks)
a) Radial nerve damage at the radial/spiral groove
b)
Anconeous Radial nerve
Brachioradialis Radial nerve
Extensor carpi radialis longus Radial nerve
Extensor carpi radialis brevis Deep branch of radial nerve
Extensor digitorum Deep branch of radial nerve
Extensor digiti minimi Deep branch of radial nerve
Extensor carpi ulnaris Deep branch of radial nerve
supinator Deep branch of radial nerve
Abductor pollicis longus Deep branch of radial nerve
Extensor pollicis brevis Deep branch of radial nerve
Extensor pollicis longus Deep branch of radial nerve
Extensor indicis Deep branch of radial nerve

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 c) Brachioradialis,supinator

195. A patient presents with loss of skin sensations from medial 1½ fingers on both
palmar and dorsal aspects of his left hand. He could not grip a paper between his
middle and ring fingers and also unable to flex the terminal phalanges of ring
finger and little finger also. With your anatomy knowledge,
a. Mention the root value of the nerve involved in this case.
b. Give reasons for:
i. Loss of sensation
ii. Loss of ability to grip the paper
iii. Loss of ability to flex the terminal phalanx
(4 marks)
Please refer the previous answers
196. A young man slipped while climbing a tree. In order to save himself, he clutched
onto a branch of the tree. At the hospital, the doctors found that his hand had a
clawed appearance with hyper-extended metacarpo-phalangeal joints and flexed
interphalangeal joints.
a. Which trunk of the brachial plexus was likely to have been injured in this
case?
b. Which muscles are responsible for flexion of metacarpo-phalangeal joints?
What is the nerve supply to these muscles?
c. What are the types and subtypes of the metacarpo-phalangeal and
interphalangeal joints?
(1+2+2=5 marks)
a) Lower trunk of brachial plexus
b) Please refer the previous answers
c) Metacarpophalangeal joint
Type: synovial
Subtype: ellipsoid
Interphalangeal joint
Type: synovial
Subtype: hinge joint

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197. A 6 year old boy running along a concrete path with a glass jar in his hand, slipped
and fell. The glass from the broken jar pierced the skin on the front of his left
wrist. On examination, a small wound was found on the front of the left wrist and
the palmaris longus tendon had been severed. The thumb was laterally rotated and
abducted and the boy was unable to oppose his thumb to the other fingers. There
was loss of sensation in the skin of the lateral half of the palm and the palmar
aspect of the lateral three and a half fingers.
a. Name the nerve injured in this case.
b. What is its origin and root value?
c. Explain its motor distribution in the forearm and hand.
(½+1+2½=4 marks)
a) Median nerve
b) Please refer the previous answers

198. A 56 year old woman complaining of severe `pins and needles' in the hand and
lateral fingers visited her physician. She also had wasting of thenar muscles.
a. Mention the clinical condition resulted.
b. Name the nerve involved in this condition and mention its distribution in the
palm.
(1+1+1½=3½ marks)
a) Carpal tunnel syndrome
b) Please refer the previous answers

199. A patient complains of loss of sensation on palmar aspect of lateral 3½ fingers of

his right hand. He also says that he has lost the movement of opposition in the same
hand.
a. Which is the nerve involved in this case?
b. What is the root value of that nerve?
c. Name the muscles supplied by that nerve in the hand.
(1+1+2=4 marks)
a) Median nerve
b) Please refer the previous answers
c) Please refer the previous answers

Durga & Sathis

200. A patient presented with burning "pins and needles" sensation in the palmar
aspect of the lateral 3½ fingers of his left hand. The doctor noticed that cutaneous
sensation over the thenar eminence was normal but the thumb was adducted and
laterally rotated, giving the appearance of an "ape"-like hand.
a. What is the name of this condition?
b. Which is the nerve affected in this case?
c. Name the muscles affected by this condition.
d. Why did the doctor find normal sensation for the skin over the thenar
eminence?
(1+1+2½+1=5½ marks)
a) Carpal tunnel syndrome
b) Median nerve
c) abductor pollicis brevis, fexor pollicis brevis, opponens pollicis,1st& 2nd lumbricals
d) branch of the median nerve supplying it arises in the forearm

201. Due to a difficult delivery, the lower trunk of the brachial plexus was severely
stretched on the right side of the baby.
a. Which are the nerves that could be affected in such a trauma?
b. Where do you expect loss of sensation?
c. What is the position of the fingers of the right hand?
(3+1+1=5 marks)
a) Ulnar nerve, median nerve, radial nerve, medial pectoral nerve, medial cutaneous
nerve of the arm, medial cutaneous nerve of forearm, thoracodorsal nerve
b) Along the medial border of the arm, forearm and hand
c) Claw hand due to unopposed action of the long flexors and extensors of the fingers.
There is hyperextension at the metacarpophalangeal joints & flexion at the
interphalangeal joints.

Durga & Sathis

202. Following a left radical mastectomy, a 53 year old woman was unable to lift her left
arm above her head. The medial border of her left scapula protruded abnormally.
a. For what condition is radical mastectomy usually prescribed?
b. Which is the nerve that was cut during the operation?
c. Explain abduction of the arm in three steps, naming the muscles responsible
for each stage
d. What is the name of her clinical condition?
(1+1+1+3=6 marks)
a) For treatment of breast cancer
b) Long thoracic nerve
c)
1. First 15 degrees abductios is by supraspinatus
2. From 15-90 degrees it is by deltoid muscle
3. The serratus anterior and the trapezius increase the range of the abduction upto
180° by rotating the scapula.
d) Winging of scapula

203. A boy dislocated his shoulder joint while playing. After some time, he found that
he could not abduct his arm.
a. Which nerve is likely to be injured?
b. Give its origin, course and distribution.
(½+2½=3 marks)
a) axillary nerve
b) Please refer the previous answers
204. A motorcycle accident resulted in a fracture of the shaft of the left humerus of a
student. He also developed a "wrist drop" and loss of skin sensation on the
posterior aspect of the forearm.
a. What is wrist drop?
b. Which is the nerve involved in this case?
c. Mention the root value of the nerve and name the muscles supplied by it.
(1+1+3=5 marks)
a) Wrist drop is a condition where there is loss of power of extension at the wrist
b) Radial nerve
c) Please refer the previous answers

Durga & Sathis

205. A 58 year old woman fell down the stairs and fractured her right humerus. It was
noticed that she held her right forearm pronated and the wrist joint and
metacarpophalangeal joints flexed.
a. What is this clinical condition called?
b. Which nerve was involved in the fracture?
c. What is its root value?
d. Name the muscles that were paralysed in this fracture.
(1+½+½+3=5 marks)
a) Wrist drop
b) Radial nerve
c) Please refer the previous answers
d) Please refer the previous answers

206. Describe the origin, insertion, nerve supply and actions of the deltoid.
(5 marks)
Origin:
 Anterior border of lateral 1/3 of clavicle
 Lateral border of acromian
 Lower lip of crest of spine of scapula

Insertion: deltoid tuberosity of humerus

Nerve supply: axillary nerve
Actions:
a) Anterior fibres : flex & medially rotate the arm
b) Acromial fibres : powerful abductors of arm from 15 - 90°
c) Posterior fibres : extend & laterally rotate the arm

207. Give the origin, insertion, actions and nerve supply of serratus anterior. Name the
clinical condition resulting from the paralysis of it.
(1+1+½+½+1=4 marks)

Origin: In the form of 8 digitation from upper 8 ribs & from fascia covering intervening
intercostal muscles
Insertion: Into costal surface of scapula along its medial border

Durga & Sathis

Nerve supply: long thoracic nerve
Actions:
 Along with pectoralis minor, pulls the scapula forwards
 Steadies scapula during weight carrying
 Helps in forced inspiration
 Alongwith trapezius, helps in overhead abduction

Clinical condition: winging of scapula

208. Mention the origin, insertion and actions of biceps brachii muscle. Which nerve, when
damaged, results in paralysis of this muscle?
(2+1+1+2=6 marks)
Origin:
Short head: together with coracobrachialis arises from tip of coracoid process
Long head: from supraglenoid tubercle of scapula and glenoidal labrum

Insertion: To posterior rough part of radial tuberosity

To the deep facia of forearm through the bicipital aponeurosis
Actions:
 Strong supinator when forearm is flexed
 Flexor of elbow
 Short head : flexor of arm
 Long head : prevents upward dislocation of the humerus

-Musculocutaneous nerve

209. Explain the origin, insertion, nerve supply and actions of supinator muscle.
(2+1+1+1=5 marks)

Origin: Takes origin from lateral epicondyle of humerus, lateral ligament of the elbow joint,
annular ligament of superior radioulnar joint and supinator crest of ulna
Insertion: neck & shaft of upper 1/3 of radius
Nerve supply: deep branch of radial nerve
Actions: supination of forearm when elbow is extended

Durga & Sathis

210. Name the hypothenar muscles and mention their nerve supply.
(2+½=2½ marks)
Abductor digiti minimi Deep branch of ulnar nerve
Flexor digiti minimi Deep branch of ulnar nerve
Opponens digiti minimi Deep branch of ulnar nerve

211. Explain the origin, insertion, nerve supply and actions of pectoralis major muscle.
(1+1+1+1=4 marks)
Origin:
 Its sterno-costal head arises from 2nd to 6th costal cartilages, half the breadth of
anterior surface of manubrium & and body of sternum upto 6th costal cartilage, and
aponeurosis of external oblique muscle of abdomen
 Its clavicular head arises from the anterior surface of medial half of clavicle

Insertion: on to lateral lip of bicipital groove on humerus

Nerve supply: medial and lateral pectoral nerves
Actions:
As a whole: causes adduction & medial rotation of arm
Clavicular part: flexion of arm
Sternocostal part: extension of flexed arm against resistant & in climbing

212. Explain the origin, insertion, nerve supply and actions of trapezius muscle.
(1+1+1+1=4 marks)
Origin:
 Medial 1/3 of superior nuchal line
 External occipital protuberance
 Ligamentum nuchae
 C7 spine
 T1-T12 spines
 Corresponding supraspinous ligaments
Insertion:
 Upper fibres- into posterior border of lateral 1/3 of clavicle
 Middle fibres- into medial margin of acromian & upper lip of crest of spine of scapula

Durga & Sathis

  Lower fibres- on the deltoid tubercle at the medial end of the spine of scapula

Nerve supply:
 spinal part of accessory nerve(motor)
 C3,C4 (proprioceptive)

Actions:
 Upper fibres elevate the scapula (as in shrugging)
 Middle fibres retract the scapula
 Along with serratus anterior it rotates the scapula forward round the chest wall & thus
plays role in abduction of arm beyond 90°
 Steadies the scapula

213. Explain the origin, insertion, nerve supply and actions of brachioradialis muscle.
(½+½+½+½=2 marks)
Origin: upper 2/3rd of lateral supracondylar ridge of humerus
Insertion: base of styloid process of radius
Nerve supply: radial nerve
Actions: flexes forearm at elbow joint; rotates forearm to the midprone position from supine
or prone positions

214. Name the superficial and deep muscles of the flexor compartment of the forearm.
Give their nerve supply.
(2+1=3 marks)
Superficial muscles:
Pronator teres Median nerve
Flexor carpi radialis Median nerve
Palmaris longus Median nerve
Flexor digitorum superficialis Median nerve
Flexor carpi ulnaris Ulnar nerve

Durga & Sathis

Deep muscles:
Flexor digitorum profundus Medial half by ulnar nerve & lateral half by
anterior interosseous nerve
Pronator quadratus anterior interosseous nerve
Flexor pollicis longus anterior interosseous nerve

215. Name the short (intrinsic) muscles acting on the index finger. Give their actions
and nerve supply.
(4½ marks)
First lumbrical – flexes metaarpophalangeal joint & extend interphalngeal joints, supplied by
median nerve
2nd palmar interosseus – adduct the finger towards centre of middle finger, supplied by deep
branch of ulnar nerve
1st dorsal interosseus – abducts the finger away from centre of 3rd digit, supplied by deep
branch of ulnar nerve

216. Write a note on lumbricals of the hand.

(4 marks)
4 in number & arise from 4 tendons of flexor digitorum profundus

Lumbrial Origin Insertion

Via extensor expansion into dorsum of
1st Lateral side of tendon of 2nd digit
bases of distal phalanges of index finger
Via extensor expansion into dorsum of
2nd Lateral side of tendon of 3rd digit
bases of distal phalanges middle finger

rd
Adjacent sides of tendons of 3rd and 4th Via extensor expansion into dorsum of
3
digits bases of distal phalanges of ring finger

th
Adjacent sides of tendons of 4th and 5th Via extensor expansion into dorsum of
4
digits bases of distal phalanges of little finger

Nerve supply:
1st&2nd lumbricals are supplied by median nerve, 3rd& 4th are supplied by deep branch of
ulnar nerve

Durga & Sathis

Actions: Lumbricals flex metacarpophalangeal joints and extend interphalangeal joints of 2nd
– 5th digits

217. Name the muscles attached to the lesser and greater tubercles of humerus and
mention their nerve supply.
(2 marks)
Muscles attached to lesser tubercle of humerus: subscapularis
Nerve supply: upper and lower subscapular nerves
Muscles attached to greater tubercle of humerus: supraspinatus, infraspinatus & teres minor
Nerve supply: supraspinatus & infraspinatus are supplied by suprascapular nerve
Teres minor is supplied by axillary nerve

218. Name the muscles attached to the medial epicondyle of humerus. What are the
actions of each of these muscles? What is their nerve supply?
(2+3+1=6m)

Muscles Nerve supply Actions

Pronator teres Median nerve Pronation of forearm
Flexes & abducts hand at
Flexor carpi radialis Median nerve
wrist joint
Palmaris longus Median nerve Flexes wrist joint
Flexes middle phalanx of
finger & assist in flexing
Flexor digitorum superficialis Median nerve
proximal phalanx & wrist
joint
Flexes & adducts the hand at
Flexor carpi ulnaris Ulnar nerve
the wrist joint

219. Name the muscles attached to the medial border of the scapula. Give their nerve
supply.
(2+1=3 marks)
On the dorsal surface:
Muscles Nerve supply
Levator scapulae A branch from dorsal scapular nerve

Durga & Sathis

 C3&C4 are proprioceptive
Rhomboideus minor Dorsal scapular nerve
Rhomboideus major Dorsal scapular nerve

On the costal surface:

Serratus anterior, supplied by long thoracic nerve

220. A young man, while playing basketball, had a dislocation of his shoulder joint.
Following this, he had difficulty in abducting his arm.
a. What is the commonest direction of shoulder dislocation?
b. Injury to which structure causes difficulty in abduction in this case?
c. Mention the movements possible and the muscles producing each of the
movements at the shoulder joint.
(1+1+3=5 marks)
a) Downward direction/inferiorly
b) Axillary nerve
c)
Movements Main muscles Accessory muscles
Flexion Clavicular head of pectoralis major, Coracobrachialis, short head
anterior fibres of deltoid of biceps brachii
Extension Posterior fibres of deltoid, latissimus Teres major, long head of
dorsi triceps brachii, sternocostal
head of the pectoralis major
Adduction Pectoralis major, latissimus dorsi, Teres major,
short head of biceps brachii, long head coracobrachialis
of triceps brachii
Abduction Supraspinatus 0-15° -
Deltoid 15-90°
Serratus anterior 90-180°
Upper & lower fibres of trapezius 90-
180°
Medial Pectoralis major Subscapularis
rotation Anterior fibres of deltoid
Latissimus dorsi

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 Teres major
Lateral Posterior fibres of deltoid -
rotation Infraspinatus
Teres minor

221. Describe the shoulder joint under the following headings:

a. Type and subtype
b. Articular surfaces
c. Attachments of fibrous capsule
d. Muscles producing various movements.
(1+1+2+2=6 marks)
a) Type: synovial
Subtype: ball & socket

b) Glenoid cavity of scapula & head of humerus

c)
Medially: attached to scapula beyond supraglenoid tubercle & margins of labrum
Laterally: to anatomical neck of humerus
Inferiorly: extends down to surgical neck
Superiorly: deficient for passage of long head of biceps brachii

d) Please refer the previous answers

222. Name the structures involved in the formation of rotator cuff of shoulder joint.
(2½ marks)
Please refer the previous answers

223. Write a short note on rotator cuff tendinitis.

(4 marks)
The muscle most commonly involved is supraspinatus as it passes beneath the acromian and
the acromioclavicular ligament. The space, in which the supraspinatus tendon passes, is of
fixed dimensions. Swelling of the supraspinatus muscle, excessive fluid within the
subaromial/subdeltoid bursa or subacromial bony spurs may produce significant impingement
when arm is abducted.

Durga & Sathis

The blood supply to the supraspinatus tendon is relatively poor. Repeated trauma, in certain
circumstances, makes the tendon susceptible to degenerative changes, which may result in
calcium deposition, producing extreme pain.

When the supraspinatus tendon has undergone significant degenerative change, it is further
susceptible to trauma and partial or full thickness tears may develop. These tears are most
common in older patients and may result in considerable difficult in carrying out normal
activities.

224. Explain the boundaries and contents of carpal tunnel. Add a note on carpal tunnel
syndrome.
(4+1½=5½ marks)
Please refer the previous answers

225. Mention the type and subtype of radioulnar joints. List the movements possible at
these joints and mention the muscles responsible for these movements.
(1+1+2=4 marks)
Please refer the previous answers

226. Name the joints at which pronation and supination movements occur. Mention the
type and subtype of those joints. Enumerate the muscles responsible for supination
and pronation.
(1+1+2=4 marks)

 superior radioulnar joint

Type: synovial
Subtype: pivot

 inferior radioulnar joint

Type: synovial
Subtype: pivot

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 Movements possible:
 Supination is brought about by supinator muscle & biceps brachii
 Pronation is chiefly brought about by pronator qudratus. It is aided by pronator teres.
 Brachioradialis helps both in pronation and supination

227. Define the movements of pronation and supination. At what joints do these
movements take place? Name the muscles, which bring about supination and give
their nerve supply.
(1+1+1=3 marks)
Supination and pronation are rotatory movements of the forearm and hand around a
vertical axis. In a semiflexed elbow, the palm is turned upwards in supination and
downwards in pronation. The movements are permitted at superior and inferior
radioulnar joints.
 Supination brought about by supinator muscle & biceps brachii

Supinator muscle is innervated by deep branch of radial nerve

Biceps brachii is innervated by musculucutaneous nerve

228. Discuss movements of the thumb and the muscles performing these movements.
(4 marks)
1. Abduction of thumb – brought about by abductor pollicis longus and brevis muscles
2. Adduction of thumb - brought about by adductor pollicis
3. Flexion of metacarpophalangeal joint of thumb – by flexor pollicis brevis muscle and
flexion of the interphalangeal joint by the flexor pollicis longus muscle
4. Opposition of thumb toward the finger – by opponens pollicis

229. Name the muscles attached to anterior and posterior surfaces of interossious
membrane. In which position of the forearm does it become taut?
(3+1=4 marks)
On the anterior surface: flexor digitorum profundus & flexor pollicis longus
On the posterior surface: abductor pollicis longus, extensor pollicis brevis, extensr indicis,
extensor pollicis longus
It becomes taut when the forearm is midway between supine and prone positions

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230. Name the boundaries (walls) and structures forming each of the boundaries of
axilla. Mention its contents. Which of the contents of the axilla is enlarged in
cancer of the breast?
(4+2=6 marks)
Boundaries (walls)
Anterior wall: formed by
a) Pectoralis major
b) Clavipectoral fascia
c) Pectoralis minor

Posterior wall: formed by

a) Subscapularis
b) Teres major & latissimus dorsi

Medial wall: formed by

a) Upper 4 ribs with their intercostal muscles
b) Upper part of the serratus anterior muscle

Lateral wall: formed by

a) Upper part of the shaft of the humerus in region of bicipital groove
b) Coracobrachialis & short head of biceps brachii

Contents of axilla:
1. Axillary artery and its branches
2. Axillary vein and its tributaries
3. Infraclavicular part of brachial plexus
4. 5 groups pf axillary lymph nodes & associated lymphatics
5. Long thoracic & intercostobrachial nerve
6. Axillary fat & areolar tissue

In cancer of breast the lymph nodes will become enlarged.

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231. Name the boundaries of the quadrangular space. Name the structures passing
through it.
(2+1=3 marks)
Boundaries:
Superior:
a) Subscapularis in front
b) Capsule of shoulder joint
c) Teres minor behind

Inferior: teres major

Medial: long head of triceps brachii
Lateral: surgical neck of humerus
Structures passing through it: axillary nerve & posterior circumflex humeral vessels

232. Write a note on midpalmar space.

(5 marks)
Features Midpalmar space
Shape Triangular
Situation Under the inner half of the hollow of the palm
Extent :
Proximal Distal margin of flexor retinaculum
Distal Distal palmar crease
Communications:
Proximal Forearm space
Distal Fascial sheaths of the 3rd& 4th lumbricals

Boundaries :
 Flexor tendons of 3rd,4th,5th fingers
Anterior
 2nd,3rd& 4th lumbricals
 Palmar aponeurosis

Fascia covering interossei & metacarpals

Posterior
Intermediate palmar septum
Lateral
Medial palmar septum
Medial

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 Drainage Incision in either the 3rd or 4th web space

233. Write a note on palmar aponeurosis.

(5 marks)

Palmar aponeurosis is triangular in shape. The apex which is proximal blends with the flexor
retinaculum & is continuous with tendon of palmaris longus. The base is directed distally. It
divides into 4 slips opposite the heads of the metacarpals of the medial 4 digits. Each slip
divides into 2 parts which continuous with fibrous flexor sheaths. From the lateral and medial
margins of palmar aponeurosis, the lateral and medial palmar septa pass backwards and
divide the palm into compartments.
Function on palmar aponeurosis:
Fixes the skin of palm & thus improves the grip. It also protects the underlying tendons,
vessels & nerves.
Clinical anatomy: Depuytren’s contracture
 Due to inflammation involving ulnar side of palmar aponeurosis. There is thickening
& contraction of aponeurosis. As a result the proximal phalanx & later the middle
phalanx become flexed and cannot be straigtened. Terminal phalanx is unaffected.
Ring finher is commonly involved.

Durga & Sathis

234. Enumerate the tendons passing deep to the extensor retinaculum.
(3 marks)

The space deep to extensor retinaculum is divided into 6 compartments. Lateralmost

compartment is called first compartment. Following are the tendons passing through each of
the compartments:
First compartment: abductor pollicis longus and extensor pollicis breivis
Second compartment: Extensor carpi radialis longus and brevis
Third compartment: Extensor pollicis longus
Fourth compartment: extensor digitorum, extensor indicis, posterior interosseous nerve and
anterior interosseous artery
Fifthe compartment: Extensor digiti minimi
Sixth compartment: Extensor carpi ulnaris

235. Write short notes on clavipectoral fascia.

(3 marks)
 It is a fibrous sheet situated deep to clavicular portion of pectoralis major muscle
 Extends from clavicle above to axillary fascia below
 Upper part splits to enclose subclavius muscle
 Inferiorly split to enclose pectoralis minor
 Below pectoralis minor continuous as suspensory ligament of axilla

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It is pierced by:
 Lateral pectoral nerve
 Cephalic vein
 Thoracoacromial vessels
 Lymphatics

236. List the structures forming the roof and floor of cubital fossa.
(1½+½=2 marks)
Roof of cubital fossa is formed by:
i) Skin
ii) Superficial fascia containing median cubital vein, lateral cutaneous nerve of
the forearm & the medial cutaneous nerve of the forearm.
iii) Deep fascia
iv) Bicipital aponeurosis

Floor of cubital fossa is formed by: brachialis & supinator muscles.

Durga & Sathis

237. A 35 year old man was seen in the emergency room with the inferior dislocation of
the shoulder joint. Even after the correction of the dislocation, the patient was
unable to abduct his shoulder and had anaesthesia over the lower half of the
deltoid muscle. The senior doctor said a branch of the brachial plexus had been
injured during the dislocation.
a. Name the nerve injured during the dislocation.
b. Give its root value, course and distribution.
c. Name the muscle responsible for the loss of abduction at the shoulder.
(1+3+1=5 marks)
a) Axillary nerve
b) Please refer the previous answers
c) Deltoid

238. Give an account of the location and areas of drainage of the axillary lymph nodes.
(1½+1½=3 marks)
1. Anterior/pectoral group – lie along the lateral thoracic vessels (along the lower border
of pectoralis minor.
-receive lymph from upper half of the anterior wall of the trunk & from major part of
breast.
2. Posterior/scapular group – lie along the subscapular vessels, on the posterior fold of
axilla
-receive lymph from posterior wall of the upper half of the trunk, and from axillary
tail of breast.
3. Lateral group - lie along upper part of humerus, medial to axillary vein
-receive lymph from upper limb
4. Central group – lie in fat of upper axilla
-receive lymph from preceeding groups and drain into apical group.
5. Apical/infraclavicular group – lie deep to the clvipectoral fascia, along the axillary
vessels
-receive lymph from the central group, from upper part of breast, and from thumb &
its web

239. Name the origin, course, termination and branches of dorsalis pedis artery.
(1+1+1+1=4 marks)
Origin: continuation of anterior tibial artery (begin in front of the ankle between 2 malleoli)

Durga & Sathis

Course: passes forwards along the medial side of the dorsum of the foot to reach the proximal
end of the 1st intermetatarsal space.
Termination: it dips downwards between the 2 heads of the 1st dorsal interosseous muscle,
and ends the sole by completing the plantar arterial arch.
Branches:
1. Lateral tarsal artery
2. Medial tarsal branches
3. Arcuate artery
4. 1st dorsal metatarsal artery

240. Describe the bones forming and the structures maintaining the medial longitudinal
arch of the foot. What are the functions of the arches of the foot?
(2+2+1=5 marks)
Please refer the previous answers
241. Give an account of the origin and root value, deep (anterior) relations and
branches of sciatic nerve.
(1+2+2=5 marks)
Please refer the previous answers

242. A 27 year old woman was found to have an unstable right knee joint following a
severe automobile accident. On examination, it was possible to pull the tibia
excessively forward on the femur. The doctor said that it was due to the rupture of
an intra-articular structure.
a. Name the structure ruptured and give its attachments.
b. Mention the other intra-articular structures of the knee joint.
c. Describe the locking mechanism of the knee joint.
(1½+1½+2=5 marks)

a. Anterior cruciate ligament

b. Please refer the previous answers

243. Describe the attachments, nerve supply, openings and actions of adductor magnus
muscle.
(2+1+1+1=5 marks)
Please refer the previous answers

Durga & Sathis

244. Give an account of the extent, course and relations of the popliteal artery. Name
its branches.
(1+3+1=5 marks)
Please refer the previous answers

245. Name the major artery in the adductor canal. Mention its origin, course,
termination and branches.
(1+1+1+1½=4½ marks)
Femoral artery
Please refer the previous anwers

246. Explain the origin, course and termination of great saphenous vein. Mention its
tributaries.
(½+1+½+1=3 marks)
Please refer the previous answers

247. A patient underwent a coronary bypass surgery. The surgeon grafted a superficial
vein of the lower limb to bypass the obstructed part of coronary artery.
a. Which is the vein of the lower limb that is used in this case?
b. Explain the origin, course and termination of that vein.
c. What is the alternate route taken up by the blood which was passing
through that vein?
(1+3+1=5 marks)
a) Great saphenous vein
b) Origin: begins on the dorsum of foot from the medial end of dorsal venous arch
Course and termination: runs upwards in front of the leg, & behind the knee. In the
thigh it inclines forwards to reach the saphenous opening where it pierces the
cribriform fascia and terminates by opening into the femoral vein
c) The vein is connected to the deep viens through perforating veins. There are 3 medial
perforators just above the ankle, 1 perforator just below the knee, and another 1 in the
region of adductor canal.

Durga & Sathis

248. Mention the nerve of the anterior compartment of the thigh. Give its root value
and distribution.
(1+½+2½=4 marks)
Femoral nerve
Please refer the previous answers

249. Give an account of the origin, root value, course, relations and distribution of the
sciatic nerve.
(½+½+1+3+1=6 marks)
Please refer previous answers

250. Mention the origin, root value, course and distribution of obturator nerve in the
thigh.
(½+½+1+2=4 marks)
Origin: It is a branch of lumbar plexus.
Root value: Ventral divisions of ventral rami of L2, L3&L4 spinal nerves
Course: emerges on the medial border of psoas major muscle within the abdomen. It crosses
the pelvic brim to run downwards and forwards on the lateral wall of pelvis to reach the
upper part of obturator foramen. It ends by dividing into anterior and posterior divisions.
Distribution:
Anterior division Posterior division
Muscular Pectineus, adductor longus, Obturator externus, adductor
adductor brevis, gracilis magnus(adductor part)
Articular Hip joint Knee joint
Vascular & cutaneous Femoral artery, medial side Popliteal artery
of thigh

251. Radiological examination of a man aged 25 years revealed the fracture of neck of
fibula. The patient was unable to dorsiflex his foot at the ankle joint.
a. What is the clinical term used to explain this disability?
b. What is the nerve injured in this case?
c. Name the muscles supplied by that nerve directly or indirectly.
(1+1+1½=3½ marks)
a) Foot drop

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 b) Common peroneal nerve
c) Tibialis anterior, extensor halluces longus, extensor digitorum longus, peroneus
tertius, extensor digitorum brevis,peroneus longus & peroneus brevis

252. Describe the sensory innervation of the foot.

(5 marks)

The superficial peroneal nerve divides into medial and lateral plantar branches. These
branches supply skin over the entire dorsum of foot except the following areas;
 Lateral border (lateral border is supplied by sural nerve)
 Medial border up to the base of the great toe (Medial border is supplied by saphenous
nerve)
 Cleft between the first & second toes (supplied by the deep peroneal nerve)

The skin of sole is supplied by 3 cutaneous nerves;

 Medial calcanean branches of tibial nerve – to posterior and medial portions
 Branches from medial plantar nerve to the larger, anteromedial portion including the
medial 3 and a half digits
 Branches from lateral plantar nerve to the smaller anterolateral portion including
lateral 1 and a half digits

Durga & Sathis

253. Name the nerves of different compartments of the thigh. Mention the origin, root
value, course and distribution of any one of them.
(1½+½+½+1+1½=5 marks)
Medial side of thigh: obturator nerve
Front of thigh: femoral nerve
Back of thigh: sciatic nerve
Please refer the previous answers
254. Give the attachments, nerve supply and actions of the adductor magnus muscle.
Enumerate the structures passing through it.
(2+1+1+1=5 marks)
Please refer the previous answers

255. Name the muscle which unlocks the knee joint. Mention its attachments and nerve
supply.
Popliteus
Please refer the previous answers

256. Mention the muscle supplied by the inferior gluteal nerve. Explain the origin,
insertion and actions of that muscle.
Gluteus maximus
Origin:
 Outer slope of the dorsal segment of iliac crest
 Posterior gluteal line
 Posterior part of gluteal surface of ilium behind the posterior gluteal line
 Aponeurosis of erector spinae
 Dorsal surface of lower part of sacrum
 Side of coccyx
 Sacrotuberous ligament
 Fascia covering gluteus medius

Insertion:
 Deep fibres inserted into gluteal tuberosity
 Greater part of muscle inserted into iliotibial tract

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Actions:
 Chief extensor of thigh at hip joint
 Lateral rotation of thigh
 Along with tensor fasciae latae stabilises knee through iliotibial tract

257. Upon clinical examination, a patient was found to bend his trunk to the right side
while lifting his left foot and to the left side while lifting his right foot. With your
knowledge of anatomy answer the following.
a. What do you call for such type of gait in clinical terms?
b. Name the muscles which might have been paralysed.
(1+1=2 marks)
a) Waddling gait ( Note: if it is unilateral, it is called “Lurching gait”)
b) Gluteus medius & gluteus minimus

258. A 25 year old man was admitted to the hospital following an automobile accident.
He was found to have a fracture of the middle third of the shaft of right femur. On
examination, the right leg showed 2 inches of shortening. A lateral radiograph
showed overlap of the fragments, with the distal fragment rotated backward.
a. Why there was a shortening of the right leg?
b. Why was the distal fragment rotated posteriorly?
c. Mention the muscles attached to the lesser trochanter of femur.
(1+1+1=3 marks)
a) Shortening was because of the contracture of the hamstrings
b) Backward rotation of distal fragment was due to the reverse action of gastrocnemius
c) iliacus & psoas major

259. List the muscles of anterior compartment of leg. Mention the attachments and
nerve supply of the muscle in this compartment which inverts the foot.
(2+2+1=5 marks)
1. tibialis anterior
2. extensor halluces longus
3. extensor digitorum longus
4. peroneus tertius
5. extensor digitorum brevis

Durga & Sathis

Muscle that inverts the foot: tibialis anterior

Origin:
a) lateral condyle of tibia
b) less of the lateral surface of shaft of tibia
c) adjoining part of interosseous membrane

Insertion: inferomedial surface of medial cuneiform & adjoining part of the base of 1st
metatarsal bone
Nerve supply: deep peroneal nerve

260. What are the muscles responsible for the inversion and eversion of foot?
(1½ marks)
Inversion of foot: tibialis anterior, tibialis posterior
Eversion of foot by: peroneus tertius, peroneus longus & peroneus brevis

261. Mention the two major muscles producing inversion of foot. Explain the origin,
insertion and nerve supply of any one of them.
(1+1+1+½=3½ marks)
Tibialis anterior & tibialis posterior

Tibialis posterior:

Origin:
a) lateral part of posterior surface of tibia below soleal line
b) posterior surface of fibula in front of the medial crest
c) posterior surface of interosseous membrane

Insertion: tuberosity of navicular bone & other tarsal bones except talus. Insertion is extended
into 2nd, 3rd& 4th metatarsal bones at their bases.

Nerve supply: tibial nerve

Durga & Sathis

262. Name the muscles attached to posterior surface of tibia.
(2 marks)
Popliteus & semimembranosus (insertion)
Soleus, flexor digitorum longus tibialis posterior (origin)

263. A 25 year old boy met with an accident following which he started experiencing
numbness and tingling sensation down the anterior and lateral sides of the right leg
and dorsum of foot. On examination he tended to hold his foot plantar-flexed and
slightly inverted. Radiograph revealed dislocation of hip joint.
a. What is the commonest direction of dislocation of hip joint and why?
b. Name the nerve damaged in the above case.
c. Discuss the different movements and muscles bringing about the movements
at hip joint.
(2+½+3=5½ marks)
a) Posteriorly
b) Sciatic nerve
Please refer the previous answers
264. A 60 year old patient admitted to the hospital presents with shortened and laterally
rotated left lower limb. Upon examining the radiograph, the doctor diagnosed it as
dislocation of hip joint.
a. Name the muscles responsible for shortening and lateral rotation of lower
limb in this case.
b. Mention the type and subtype of hip joint. Name its articular surfaces.
Mention the movements and muscles producing each of the movements
occurring at that joint
(1+1+1+4½=7½ marks)
a) Please refer the previous answers

Movement Chief muscles Accessory muscles

Flexion Psoas major & iliacus Pectineus, rectus femoris,
& Sartorius
Extension Gluteus maximus & hamstrings -
Abduction Gluteus minimus & medius Tensor fascia latae &
Sartorius

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 Adduction Adductor longus, brevis & magnus Pectineus & gracilis
Medial rotation Tensor fascia latae, & anterior fibres -
of glutei medius & minimus
Lateral rotation 2 obturators & 2 gemelli & quadratus Piriformis, gluteus
femoris maximus & sartorius

265. Describe the hip joint under the following headings:

a. Articular parts
b. Names of ligaments
c. Movements and muscles producing movements
d. Nerve supply
(1+1½+3+1=6½ marks)

a) head of femur & acetabulum of hip bone

b)
i. Fibrous capsule
ii. Iliofemoral ligament
iii. Pubofemoral ligament
iv. Ischiofemoral ligament
v. Ligament of the head of femur/ round ligament
vi. Acetabular labrum
vii. Tranverse acetabular ligament

c)
Movement Chief muscles Accessory muscles
Flexion Psoas major & iliacus Pectineus, rectus femoris,
& Sartorius
Extension Gluteus maximus & hamstrings -
Abduction Gluteus minimus & medius Tensor fascia latae &
Sartorius
Adduction Adductor longus, brevis & magnus Pectineus & gracilis
Medial rotation Tensor fascia latae, & anterior fibres -
of glutei medius & minimus

Durga & Sathis

 Lateral rotation 2 obturators & 2 gemelli & quadratus Piriformis, gluteus
femoris maximus & sartorius

d) Nerve supply : supplied by femoral nerve, through nerve to rectus femoris : the
anterior division of obturator nerve; the nerve to the quadratus femoris & the superior
gluteal nerve

266. In one of the severe road accidents, a college boy was found to have an unstable
right knee joint. On examination under anesthesia, the surgeon was able to pull the
tibia forward excessively on the femur. The surgeon diagnosed an injury to one of
the ligaments of the knee.
a. Name the ligament injured in this case?
b. Give the attachments and functions of that ligament
(1+2=3 marks)
a) Anterior cruciate ligament
b) Please refer the previous answers
Functions: maintains anteroposterior stability of knee joint

267. Following a severe automobile accident, a 25 year old woman was found to have an
unstable knee joint. On examination under an anesthetic, it was possible to pull
the tibia forward excessively on the femur.
a. What structure was damaged in the knee joint?
b. What are its attachments?
c. List the movements possible at the knee joint and mention the muscles
producing each of these movements.
(1+1+3=5 marks)
a) Anterior cruciate ligament

Please refer the previous answers

Durga & Sathis

268. Harish, a 20-year old athlete, was brought to the hospital following an accident
while running. His knee was twisted while it was bent. The doctor suspected a case
of lateral meniscal tear and conducted further investigations to confirm his
suspicions.
a. Name any two functions of the menisci.
b. Describe briefly the mechanism of locking and unlocking of the knee joint.
(2+3=5 marks)
a)
i. Serve as shock absorber
ii. Lubricating the joint cavity
iii. Have a sensory function. They give rise proprioceptive impulses
iv. Make the articular surfaces more congruent

b)
Please refer the previous answers

269. Write a note on shape, attachments and functions of menisci of knee joint. Which
of the menisci is commonly injured? Why?
(2+½+½=3 marks)
Medial meniscus Lateral meniscus
Shape Semicircular Nearly circular
Anterior end: anteriormost end of the Anterior end: intercondylar
intercondylar area area, just behind the lower
Posterior end: posterior part of attachment of anterior
intercondylar area in front of the lower cruciate ligament
Attachments
attachment of the posterior cruciate Posterior end: intercondylar
ligament area, just behind the
attachment of anterior end of
lateral meniscus

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Functions:
i. Serve as shock absorber
ii. Lubricating the joint cavity
iii. Have a sensory function. They give rise proprioceptive impulses
iv. Make the articular surfaces more congruent
Medial meniscus is more prone to structure because of its fixity to the tibial collateral
ligament and because of greater exercution during rotatory movements.

270. Define the movements of dorsiflexion and plantarflexion. At what joint do these
movements occur? Name the muscles producing these movements.
(1+½+2½=4 marks)
Dorsiflexion: when dorsum of foot is brought close to front of leg and sole faces forwards
Planter flexion: when sole of foot or plantar aspect of foot faces backwards.

These movements take place at ankle joint.

Dorsiflexion is brought about by: tibialis anterior, extensor halluces longus, extensor
digitorum longus, and peroneus tertius

Plantarflexion is brought about by: tibialis posterior, gastrocnemius & soleus.

Durga & Sathis

271. A nurse administered antibiotics to a patient by intramuscular injection to the
gluteal region. Following this, the patient felt numbness in the posterior and lateral
aspects of the leg. He also had difficulty in moving his foot.
a. Name the nerve involved in the above case and mention its root value.
b. Which is the safest quadrant of gluteal region to give intramuscular
injections?
c. List the movements of ankle joint and name the muscles responsible for each
of these movements.
(1+1+3=5 marks)
a) Sciatic nerve
Root value: ventral rami of L4,L5,S1,S2,S3

b) Anterosuperior quadrant
c)

Dorsiflexion is brought about by: tibialis anterior, extensor halluces longus, extensor
digitorum longus, and peroneus tertius

Plantarflexion is brought about by: tibialis posterior, gastrocnemius & soleus.

272. Define the movements of inversion and eversion. Name the joints at which these
movements occur. Mention the muscles producing these movements.
(1+1+2=4 marks)
Inversion: when medial border of foot is raised from the ground
Eversion: when lateral border of foot is raised from the ground

This movement takes place at subtalar & talocalcaneonavicular joint.

Inversion is brought about tibialis anterior and tibialis posterior

Eversion is brought about by peroneus tertius, peroneus longus & peroneus brevis.

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273. What are the bones taking part in the medial longitudinal arch? What are the
conditions of the feet when the arches are lost and exaggerated?
(2+1+1=4 marks)
1st, 2nd, 3rd metatarsal bones, 3 cuneiform bones, navicular bone, talus and calcaneum

When arches are lost it leads to flat foot (pes planus)

When arches are exaggerated it leads to pes cavus.

274. Name the bones forming medial longitudinal arch of the foot. Mention the factors
maintaining this arch.
(1½+2=3½ marks)
Please refer the previous answers

275. Write a short note on superficial inguinal lymph nodes.

(3 marks)
 Variable in number & size
 Their arrangement is T–shaped, there being a lower vertical group and upper
horizontal group. The upper nodes are subdivided into upper lateral &upper medial
groups.
 Efferents of these nodes drain into deep inguinal nodes

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276. What is femoral canal? What is its clinical importance?
(1+1=2 marks)
Femoral canal is the medial compartment of femoral sheath. It is conical in shape, being wide
above & narrow below. The base of femoral canal is called femoral ring. The boundaries of
the ring are;

Anteriorly: ingunal ligament

Posteriorly: pectineus & its covering fascia
Medially: cancave margin of lacunar ligament
Laterally: septum separating it from femoral vein

Femoral canal contains a lymph node of Cloquet/ of Rosenmuller, lymphatics and areolar
tissue.

Clinical importance: Femoral canal is the weakpoint through which femoral hernia can
protrude to the femoral triangle. In cases of strangulation of a femoral hernia, the surgeon has
to enlarge the femoral ring. This is possible by cutting the lacunar ligament which forms the
medial boundary of the ring. Normally, this can be done without danger. However an
abnormal obturator artery may lie along the edge of the lacunar ligament; and cutting it may
cause alarming haemorrhage.

277. Mention the structures forming each of the boundaries of the popliteal fossa. Name
its contents.
(3+2=5 marks)
Superolaterally: biceps femoris
Superomedially: semimembranosus, semitendinosus,supplemented by gracilis, sartorius &
adductor magnus
Inferomedially: medial head of gastrocnemius
Inferolaterally: lateral head of gastrocnemius,supplemented by plantaris
Contents of popliteal fossa:
1. Popliteal artery and its branches
2. Popliteal vein and its tributaries
3. Tibial nerve and its branches

Durga & Sathis

 4. Common peroneal nerve and its branches
5. Posterior cutaneous nerve of the thigh
6. Genicular branch of the obturator nerve
7. Popliteal lymph nodes
8. Fat

278. Mention the structures forming each of the boundaries of femoral triangle and list
its contents.
(3+2=5 marks)
Boundaries:
Laterally: by medial border of sartorius
Medially: by medial border of adductor longus
Base: by inguinal ligament
Apex: point where medial & lateral boundaries meet
Contents:
1) Femoral artery and its branches
2) Femoral vein and its tributaries
3) Femoral sheath enclosing upper 4cm of femoral vessels
4) Nerves: femoral nerve, nerve to pectineus, femoral branch of genitofemoral nerve,
Lateral cutaneous nerve of thigh
5) Deep inguinal lymph nodes

279. Mention the boundaries and contents of adductor canal.

(3+2=5 marks)
Please refer the previous answers

280. Describe the femoral sheath in detail. What is its clinical importance?
(4+1=5 marks)

Please refer the previous answers

281. Explain the different stages of mitosis.

(5 marks)
There are 4 phases in mitosis; prophase, metaphase, anaphase & telophase

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Prophase: in this phase, the chromosomes shorten & thicken. Each chromosome is made up
of 2 chromatids which are joined at centromere. The centrioles begin to separate & move
towards the opposite pole. Microtubules are formed, which form mitotic spindles & asters.
Toward the end of prophase, the nucleolus & nuclear membrane disintegrate & the
chromosomes are released from the nucleus to the cytoplasm.
Metaphase: during this phase, the microtubules moves to the centre of the call & the
chromosomes move to the equator of the spindle. The chromosomes attach to the spindle by
their centromeres.
Anaphase: in this phase, the centromere splits into 2 & the chromosomes splits longitudinally
into 2 chromosomes, each having a chromatid. The separated chromatids start moving toward
the pole. A cleavage furrow appears on the outer aspect of the cell.
Telophase: in this pahse the chromosomes reach the opposite poles, uncoil & lengthen. The
nuclear membrane & nucleoli reappear. The cytoplasmic division is completed & the 2 cells
are separated from each other.

282. Describe the prophase of first meiotic division.

(5 marks)
It has 5 stages; leptotene, zygotene, pachytene, diplotene & diakinesis
Leptotene: the chromosomes are long & show characteristic beads throughout their length.
Zygotene: the homologous chromosomes are arranged side by side(paired) to form bivalent
pairs. This process is called synapsis; pairing /conjugation.
Pachytene: the chromosomes shorten & become visible. Each bivalent pair consist of 4
chromatids (tetrad). The 2 chromatids, 1 from each ivalent chromosomes, partially coil
around each other. This is called ‘crossing over’.
Diplotene: the chromosomes further shorten & separate fom each other except where crossing
over has occurred.(this area is called chiasmata). At the end, the chromosomes exchange their
attached segments.
Diakinesis: the chiasmata resolve & the bivalent chromosomes separate. They move towards
equatorial plane.

283. Contrast mitosis and meosis, giving four differences.

(4 marks)
1) Mitosis occurrsin all parts of the body but meiosis is restricted to gonads & is seen
only during gametogenesis

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 2) Mitosis has ony 1 division whereas the meiosis has 2 divisions
3) At the end of mitosis 2 daughter calls are formed but at the end of meiosis, 4 dughter
calls are formed
4) The daughter call of mitosis has diploid number of chromosomes but the daughter
calls of meiosis have haploid number of chromosomes.
5) The cells resulted from mitosis are identical but the ells resulted from meiosis differ in
their genetic constitution. This is because of the reassortment of genes takes place
only in meiosis.

284. Draw and label the parts of a mature human sperm.

(5 marks)
Please refer the previous answers

285. Explain the structure of the sperm.

(4 marks)
Please refer the previous answer

286. Describe the events taking place during spermatogenesis.

(3 marks)
 Please refer the previous answers

287. Draw and label the parts of a graafian follicle. (2 marks )

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288. Describe the formation of Graafian follicle.
(5 marks)
Primary oocytes remain in the prophase of first meiotic division till puberty is reached. With
the onset of puberty, 5-15 primordial follicles start to develop further. The flat follicular cells
become cuboidal and then become stratified. The follicle with a stratified epithelium is
known as a primary follicle. The stratified cells are called granulosa cells. The granulosa cells
and the oocyte, together secrete a layer of glycoprotein called zona pellucida, which separates
the oocyte from the granulosa cells. The granulosa cells become surrounded by the stromal
cells of the ovarion cortex. This layer of the stromal cell is called theca folliculi. Eventually,
the theca folliculi differentiates into 2 layers. The inner layer is called the theca interna and
the outer layer is called theca externa. Fluid filled spaces appear between the granulosa cells,
which unite to form a cavity called follicular antrum. The antrum is filled with liquor
folliculi. Now the follicle is called secondary follicle. As the follicle matures further, the
antrum enlarges and thus forms the Graafian follicle.

289. Explain the formation, functions and fate of corpus luteum.

(5 marks)
Please refer the previous answers

290. Define fertilization. Explain the different stages of fertilization.

(2+3=5 marks)
Please refer the previous answers

291. Describe the process of fertilization. What are the effects of fertilization?
(3+2=5 marks)
Please refer the previous answers
Effects of fertilization:
1. Restoration of diploid number of chromosomes. The gametes are haploid & the
human beings have diploid number of chromosomes. When gametes fuse, the diploid
number is restored.
2. Determination of sex: once fertilization is over the chromosomal sex of the embryo is
understood. The oocyte contains only X chromosomes as sex chromosomes, whereas
the spermatozoa can have either X or Y as sex chromosomes. When sperm carrying X
chromosomes fuse with oocyte, the resulting individual will be female (XX). When

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 the sperm carrying Y chromosomes fuses with oocyte, the resulting individual will be
a male (XY).
3. Initiation of cleavage: immediately after fertilization, the zygote starts to divide
mitotically. This process is called ‘cleavage’.

292. Describe the secretory phase of the menstrual cycle.

(3 marks)
Secretory phase:
Depends on progesterone and estrogen secreted by corpus luteum
Endometrium walls become thicker and have 3 layers (deep stratum basale, middle
sratum spongiosum, superficial stratum compactum)
Uterine arteries become large and tortuous and are called spiral arteries
Uterine glands are further elongated and tortuous and start secreting fluid to nourish
the embryo
If fertilisation does not occur, then corpus luteim degenerates and forms corpus
albicans
This decreases progesterone and estrogen secretion and result in shedding of
endometrium wall

293. What is ectopic pregnancy? Mention the possible sites of ectopic pregnancy. What
are the complications of ectopic pregnancy?
(½+1½+1=3 marks)
Please refer the previous answers

294. A young woman came to the hospital for an OB-GYN examination complaining of
intense abdominal pain and vaginal bleeding. She explained to the doctor that she
had missed her last two menstrual periods and thought she might be pregnant. The
doctor suspected that this might be a case of ectopic pregnancy.
a. What is ectopic pregnancy? What are the possible sites of this kind of
pregnancy?
b. Write briefly about the stages of the menstrual cycle.
(2+3=5 marks)
Please refer the previous answers

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295. Explain the formation and functions of the notochord. Mention its fate.
(4+1=5 marks)
Please refer the previous answers

296. Name four derivatives of neural crest.

(2 marks)
Please refer the previous answers

297. Name the subdivisions of intraembryonic mesoderm and mention the derivatives of
a somite.
(1½+1½=3 marks)
PARTS FATE
Paraxial mesoderm  Gives rise to somites
Intermediate  Differentiates inro urogenital
mesoderm structures
 Parietal layer-dermis of skin in
body wall and limb,bones and
Lateral plate
connective tissues of limbs and
mesoderm
sternum
 Visceral layer-wall of gut tube

298. What is somite period? Explain the formation and derivatives of the somites.
(1+4=5 marks)
Please refer the previous answers

299. Write a short note on paraxial mesoderm.

(3 marks)
th
By approximately the 17 day, cells close to the midline proliferate and form a thickened
plate of tissue known as paraxial mesoderm.
At the beginning of 3rd week, paraxial mesoderm begins to be organised into segments. These
segments, known as somitomeres, first appear in cephalic region of the embryo, and their
formation proceeds cephalicaudally. Each somitomeres consists of mesodermal cells arranged
in concentric whorls around the center of the unit.1st pair of somite appear on the 20th day of
development. From here, approximately 3 pairs of somites appear per day till the end of 5th
week. At the end a total number of 42-44 pairs are formed. There will be 4 occipital, 8

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cervical, 12 thoracic,5 lumbar, 5 sacral and 8-10 coccygeal pairs. Later, first occipital and 5-7
coccygeal somites disappear.
Fate of somites: somite differentiate to form
i. Dermatome – forms dermis of the skin
ii. Myotome – forms the segmental muscles which are attached to vertebral column
iii. Scelerotome – forms the vertebral column

300. Write a note on somite.

(3 marks)
Please refer the previous answers

301. Write a note on development of placenta.

(5 marks)
Formation of placenta:
The placenta is formed by the decidua basalis of the mother and chorion frondosum of the
blastocyst.
Chorionic villi: The villi are finger like projections of trophoblast. The trophoblast along
with the underlying extraembryonic mesoderm constitutes chorion. Hence the villi are called
chorionic villi. In the beginning the chorionic villi are formed all over the trophoblast and
they grow into the surrounding decidua. After some time, those related to the decidua
capsularis degenerate and the chorion becomes smooth. This smooth chorion is called
'chorion leavae'. The chorion related to the decidua basalis retains the villi and it is called
chorion frondosum. The chorion frondosum along with decidua basalis forms the placenta.

Formation of chorionic villi: In the second week of intrauterine life the trophoblast
differentiates into two layers; outer syncytiotrophoblast and inner cytotrophoblast. As the
syncytiotrophoblast grows, small cavities called lacunae appear in it. Soon the cavities
become larger and the area between the lacunae is called trabecula. With these changes
occurring, the syncytiotrophoblast grows into the decidua and erodes the endometrial blood
vessels. As a result, blood comes out of those vessels and fills the lacunae. Each trabeculus is
initially made up of only syncytiotrophoblast. Later the cells of cytotrophoblast multiply and
grow into each trabeculus. The trabeculus thus comes to have a central core of
cytotrophoblast and peripheral part of syncytiotrophoblast. It is now called a primary villus
and the lacunae surrounding the villus are now called intervillous spaces. The extraembryonic
mesoderm lining the trophoblast then invades the core of the primary villus. The villus now

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will have a central core of mesoderm and peripheral cyto and syncytiotrophoblasts. Such a
villus is called a secondary villus. Soon after this, blood vessels appear in the mesoderm of
the villus. Now it is known as a tertiary villus. Blood vessels of the villus communicate with
the vessels of the fetus through the umbilical vessels which are present within the umbilical
cord. The cytotrophoblast comes out of the syncytium and makes a covering to the syncytium
which is called cytotrophoblastic shell. The villi extending from chorionic plate to
cytotrophoblastic shell are called anchoring villi or truncus chorii. The anchoring villi give
side ward branches called rami chorii and ramuli chorii.
Decidua basalis: The decidual basalis (decidual plate) sends septa into the chorion in fourth
month of intrauterine life. These septa are called decidual septa. The area of placenta that is
lying between two adjacent septa is called a maternal cotyledon.

Placental circulation: The maternal arterial blood enters the placenta through spiral arteries.
The blood is poured into the intervillous spaces. From the intervillous space, the blood return
back through the endometrial veins. Exchange of gases takes place between the blood in the
intervillous spaces and the blood vessels present in the villi. The blood vessels present in the
villi are the branches/tributaries of umbilical vessels. The umbilical vessels are different from
other vessels of the body in the type of blood they carry. The umbilical vein carries
oxygenated blood and the umbilical artery carries deoxygenated blood.
Placental membrane (barrier): The placental membrane constitutes all those tissues which
separate the blood in the intervillous space from the blood in the vessels of the villus. Up to
first 4 months of intrauterine life the membrane is formed by endothelium of fetal vessel,
connective tissue of villus, cytotrophoblast and the syncytiotrophoblast. After 4th month of
intrauterine life the membrane becomes very thin due to the degeneration of the mesoderm
and cytotrophoblast of the villus and it is formed by only the endothelium of fetal vessel in
the villus and the syncytiotrophoblast

302. Describe the placental membrane/barrier and its functions.

(3 marks)
The placental membrane constitutes all those tissues which separate the blood in the
intervillous space from the blood in the vessels of the viilus. Up to 1st 4 months of
intrauterine life the membrane is formed by endothelium of fetal vessel, connective tissue of
villus, cytotrophoblast and the syncytiotrophoblast. After 4th month of intrauterine life the
membrane become very thin due to the degeneration of the mesoderm and cytotrophoblast of

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the villus and it is formed by only the endothelium of fetal vessels in the villus and the
syncytiotrophoblast.

Funtions:
 Exchange of metabolic and gaseous products such as carbon monoxide, carbon
dioxide and oxygen
 Exchange of nurients and electrolytes such as amino acid, free fatty acids and
vitamins
 Transmission of maternal antibodies
 Production of hormones like human chorionic gonadotropin (hCG), progesterone,
estrogenic hormones, gonadotropins and somatomammotropin.

303. Describe the development of chorion and chorionic villi. Name the parts of chorion
and mention their fate.
(4+1=5 marks)
Formation of chorionic villi: In the second week of intrauterine life the trophoblast
differentiates into two layers; outer syncytiotrophoblast and inner cytotrophoblast. As the
syncytiotrophoblast grows, small cavities called lacunae appear in it. Soon the cavities
become larger and the area between the lacunae is called trabecula. With these changes
occurring, the syncytiotrophoblast grows into the decidua and erodes the endometrial blood
vessels. As a result, blood comes out of those vessels and fills the lacunae. Each trabeculus is
initially made up of only syncytiotrophoblast. Later the cells of cytotrophoblast multiply and
grow into each trabeculus. The trabeculus thus comes to have a central core of
cytotrophoblast and peripheral part of syncytiotrophoblast. It is now called a primary villus
and the lacunae surrounding the villus are now called intervillous spaces. The extraembryonic
mesoderm lining the trophoblast then invades the core of the primary villus. The villus now
will have a central core of mesoderm and peripheral cyto and syncytiotrophoblasts. Such a
villus is called a secondary villus. Soon after this, blood vessels appear in the mesoderm of
the villus. Now it is known as a tertiary villus. Blood vessels of the villus communicate with
the vessels of the fetus through the umbilical vessels which are present within the umbilical
cord. The cytotrophoblast comes out of the syncytium and makes a covering to the syncytium
which is called cytotrophoblastic shell. The villi extending from chorionic plate to
cytotrophoblastic shell are called anchoring villi or truncus chorii. The anchoring villi give
side ward branches called rami chorii and ramuli chorii.

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Also refer the previous answers

304. Write short notes on:

a. Yolk sac
b. Decidua
c. Blastocyst
(3+3+2=8 marks)
a) The yolk sac is a derivative of hypoblast calls of the embryonic disc. In the 2nd
week of IUL, the cells of the hypoblast line the blastocyst cavity as they form a
membrane called Heuser’s membrane or exocelomic membrane. The new cavity
formed is called exocelomic cavity or primitive yolk sac.
The primitive yolk sac becomes smaller as the extraembryonic mesoderm and
coelom develop. After the formation of extraembryonic coelom the yolk sac is
called secondary yolk sac. Later, during the folding of the embryo the yolk sac is
incorporated into the body of the embryo. The part of yolk sac that is incorporated
into the body of the embryo will form the lining epithelium of the GIT.
Functions: serves as a nutritive role till the placenta is formed. It is the site of
development of blood cells & primordial germ cells.

Fate: yolk sac detaches from the gut in the second half of gestation and
degenerates. The detached and degenerating yolk sac can be seen in the umbilical
cord for some time of IUL.

b) Decidua is the endometrium of pregnancy. The endometrium of pregnancy is thick

and edematous. The stromal cells store glycogen. The uterine glands are thick,
tortous and secrete uterine milk. The secretion is to nourish the blastocyst and
early embryo. As the placenta develops,the placenta starts to nourish the embryo
and the role of glands diminishes. The decidua is the area where the blastocyst is
implanted. After the implantation is complete, the decidua is divided into 3 parts.
The part of decidua lying deep to the implanted blastocyst is called ‘decidua
basalis’ the decidua lying between the blastocyst and the uterine cavity is called
‘decidue capsularis’ and the rest of the decidua is called ‘decidua parietalis’. In the
late pregnancy, the decidua capsularis fuses with the decidua parietalis. The
decidua is shed during the childbirth along with the fetus and membranes.

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c) Blastocyst is the stage that appears after the stage of morula formation. A large
cavity is formed in the morula. This newly formed cavity is calld blastocele. Once
the blastocele is formed, the morula is called blastocyst. The blastocyst at this
stage contains 2 named poles. The pole on the side of inner cell mass is called
embryonic pole and the opposite pole is called aembryonic pole. At this stage, the
zona pellucida disappears and the implantation begins. Initially the blastocyst has
two cavities called amnion and primitive yolk sac. Later another cavity called
extraembryionic coelome appears in that. The mass of cells at the embryonic pole
of blastocyst is called embryoblast or inner cell mass and it gives rise to the
embryo. The outer covering of the blastocyst is called trophoblast and it gives rise
to foetal membranes

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