Chapter: Pelvis & Perineum; Topic: Pudendal Canal; Subtopic: Alcock’s Canal (Pudendal Canal)
Keyword Definitions:
Alcock’s Canal: A fascial tunnel on the lateral wall of the ischioanal fossa containing pudendal neurovascular bundle.
Pudendal Nerve: Main nerve supplying perineum.
Internal Pudendal Artery: Major arterial supply of perineum.
Ischioanal Fossa: Fat-filled space on each side of anal canal.
Inferior Rectal Nerve: Branch of pudendal nerve supplying external anal sphincter.
1) Lead Question – 2016
Content of Alcock's canal is ?
a) Internal pudendal artery
b) Internal iliac artery
c) Inferior rectal vein
d) Inferior mesenteric vein
Answer: a) Internal pudendal artery
Explanation: Alcock’s canal (pudendal canal) is a fascial canal formed by the obturator internus fascia. It contains the pudendal nerve, internal pudendal artery, and internal pudendal vein. These structures travel through the canal before giving branches to the perineum and external genitalia. It does not contain the internal iliac artery or inferior mesenteric vein. Inferior rectal vessels and nerves arise medially and usually pierce the canal walls but are not contained inside the canal. Therefore, the principal vessel within Alcock’s canal is the internal pudendal artery.
2) Pudendal nerve is a branch of?
a) L3–L4
b) S2–S4
c) L5–S1
d) S1–S2
Answer: b) S2–S4
Explanation: Pudendal nerve originates from S2–S4, supplying perineum and external genitalia.
3) Structure NOT passing through Alcock’s canal?
a) Internal pudendal vein
b) Pudendal nerve
c) Obturator nerve
d) Internal pudendal artery
Answer: c) Obturator nerve
Explanation: Obturator nerve lies in pelvis, not in pudendal canal.
4) Inferior rectal nerve supplies?
a) Internal anal sphincter
b) External anal sphincter
c) Sigmoid colon
d) Uterus
Answer: b) External anal sphincter
Explanation: Inferior rectal nerve (branch of pudendal) innervates external anal sphincter.
5) Failure of pudendal nerve block leads to loss of anaesthesia where?
a) Posterior thigh
b) Perineum
c) Chest wall
d) Foot
Answer: b) Perineum
Explanation: Pudendal nerve is the major sensory nerve of perineum.
6) Pudendal nerve exits pelvis via?
a) Lesser sciatic foramen
b) Greater sciatic foramen
c) Obturator canal
d) Femoral canal
Answer: b) Greater sciatic foramen
Explanation: It exits through greater sciatic foramen and re-enters via lesser sciatic.
7) Internal pudendal artery is a branch of?
a) External iliac artery
b) Internal iliac artery
c) Femoral artery
d) Aorta
Answer: b) Internal iliac artery
Explanation: Arises from anterior division of internal iliac artery.
8) Damage to pudendal canal during surgery can cause?
a) Foot drop
b) Fecal incontinence
c) Horner’s syndrome
d) Wrist drop
Answer: b) Fecal incontinence
Explanation: Pudendal injury affects the external anal sphincter.
9) Which muscle forms the lateral wall of Alcock’s canal?
a) Obturator internus
b) Piriformis
c) Levator ani
d) Coccygeus
Answer: a) Obturator internus
Explanation: Alcock’s canal lies within obturator internus fascia.
10) Pudendal nerve does NOT supply?
a) External urethral sphincter
b) External anal sphincter
c) Levator ani
d) Penis skin
Answer: c) Levator ani
Explanation: Levator ani is mainly supplied by S3–S4 pelvic nerves, not pudendal nerve.
11) Major blood supply to perineum is via?
a) Femoral artery
b) Internal pudendal artery
c) Inferior epigastric artery
d) Superior rectal artery
Answer: b) Internal pudendal artery
Explanation: Internal pudendal artery supplies most perineal structures.
Chapter: Abdomen; Topic: Spleen; Subtopic: Visceral Relations
Keyword Definitions:
Spleen: Intraperitoneal lymphoid organ located in the left hypochondrium.
Visceral Surface: Surface of spleen related to stomach, kidney, pancreas tail, and colon.
Splenic Flexure: Left colic flexure in contact with spleen.
Gastric Impression: Sleeve-shaped area for fundus of stomach.
Renal Impression: Area related to left kidney.
1) Lead Question – 2016
All of the following organs are in direct contact with the spleen except?
a) Duodenum
b) Stomach
c) Left kidney
d) Colon
Answer: a) Duodenum
Explanation: The spleen lies in the left hypochondrium and makes impressions on its visceral surface from the stomach (gastric impression), left kidney (renal impression), splenic flexure of colon (colic impression), and tail of pancreas. The duodenum, however, is not in direct contact with the spleen; it is located more medially and inferiorly, separated by other structures. Thus, among the listed organs, the only one not touching the spleen directly is the duodenum.
2) Tail of pancreas lies in which splenic region?
a) Renal impression
b) Gastric impression
c) Hilum
d) Colic impression
Answer: c) Hilum
Explanation: The tail of the pancreas directly enters the splenic hilum enclosed within the splenorenal ligament.
3) Splenorenal ligament contains?
a) Left gastric artery
b) Splenic vessels
c) Hepatic artery proper
d) Cystic artery
Answer: b) Splenic vessels
Explanation: Splenorenal ligament houses splenic artery and vein along with tail of pancreas.
4) Accessory spleens are most commonly found near?
a) Greater omentum
b) Splenic hilum
c) Transverse colon
d) Right kidney
Answer: b) Splenic hilum
Explanation: 75% of accessory spleens occur adjacent to the hilum.
5) Spleen develops from?
a) Foregut endoderm
b) Hindgut endoderm
c) Mesoderm of dorsal mesogastrium
d) Intermediate mesoderm
Answer: c) Mesoderm of dorsal mesogastrium
Explanation: Spleen is a mesodermal organ—not endoderm-derived.
6) A patient with splenic rupture most likely bleeds into?
a) Pelvic cavity
b) Left subphrenic space
c) Right paracolic gutter
d) Lesser sac only
Answer: b) Left subphrenic space
Explanation: Spleen lies just below diaphragm; rupture bleeds largely into left subphrenic space.
7) Organ NOT forming impression on visceral surface?
a) Stomach
b) Left kidney
c) Tail of pancreas
d) Jejunum
Answer: d) Jejunum
Explanation: Jejunum is far inferior and does not touch spleen.
8) Splenic artery is a branch of?
a) Superior mesenteric artery
b) Celiac trunk
c) Inferior mesenteric artery
d) Aorta
Answer: b) Celiac trunk
Explanation: It is one of three main branches of celiac trunk.
9) Spleen lies opposite which ribs?
a) 9–11
b) 6–8
c) 4–6
d) 11–12
Answer: a) 9–11
Explanation: Spleen is located under ribs 9–11, hence protected in normal position.
10) Splenic enlargement first crosses which costal margin?
a) Right
b) Left
c) Midline
d) Suprasternal notch
Answer: b) Left
Explanation: Splenomegaly expands toward left lower quadrant along costal margin.
11) A wandering spleen predisposes to?
a) Volvulus
b) Splenic torsion
c) Bowel obstruction
d) Renal artery thrombosis
Answer: b) Splenic torsion
Explanation: Lack of ligamentous support allows rotation of spleen around its pedicle.
Chapter: Male Reproductive System; Topic: Penis; Subtopic: Structure & Anatomical Continuity
Keyword Definitions:
Corpus Spongiosum: Erectile tissue surrounding the penile urethra and forming the glans penis.
Corpora Cavernosa: Paired erectile bodies forming most of the penile shaft except the glans.
Glans Penis: Expanded distal end of the corpus spongiosum.
Urethra: Tube conducting urine/semen, enclosed in corpus spongiosum.
Buck’s Fascia: Deep fascia binding erectile tissues together.
1) Lead Question – 2016
Glans penis is a continuation of -
a) Corpus spongiosum
b) Ischiocavernosus
c) Corpora Cavernosa
d) Puborectalis
Answer: a) Corpus spongiosum
Explanation: The glans penis represents the expanded distal part of the corpus spongiosum. The spongiosum encloses the penile urethra and continues distally to form the glans. The corpora cavernosa do not extend into the glans; instead, they terminate proximally to it. Ischiocavernosus is a perineal muscle acting on the crura of cavernosa, and puborectalis is part of the pelvic floor, unrelated to penile anatomy. Thus, the correct continuation of glans penis is the corpus spongiosum.
2) Corona of glans penis represents?
a) Margin between shaft and glans
b) Frenulum
c) External urethral meatus
d) Raphe
Answer: a) Margin between shaft and glans
Explanation: The corona forms the projecting ridge marking the junction of glans with the penile shaft.
3) Which fascia forms the deep fascia of penis?
a) Colles fascia
b) Buck’s fascia
c) Camper’s fascia
d) Dartos fascia
Answer: b) Buck’s fascia
Explanation: Buck’s fascia encases corpora cavernosa and spongiosum and maintains penile shape.
4) Penile urethra is enclosed in?
a) Corpus spongiosum
b) Corpora cavernosa
c) Suspensory ligament
d) Ischiocavernosus
Answer: a) Corpus spongiosum
Explanation: The spongiosum houses the urethra throughout its penile course.
5) Glans receives arterial supply from?
a) Dorsal artery of penis
b) Deep artery of penis
c) External pudendal artery
d) Inferior epigastric artery
Answer: a) Dorsal artery of penis
Explanation: The glans and prepuce are supplied mainly by dorsal penile arteries.
6) A child presents with penile swelling; Buck’s fascia is ruptured. Urine spreads to?
a) Abdomen deep to Scarpa’s fascia
b) Perineum superficial pouch
c) Thighs
d) Pelvic cavity
Answer: b) Perineum superficial pouch
Explanation: With Buck’s fascia rupture, urine escapes into superficial perineal space.
7) Which nerve supplies the glans penis mainly?
a) Pudendal nerve
b) Dorsal nerve of penis
c) Perineal nerve
d) Ilioinguinal nerve
Answer: b) Dorsal nerve of penis
Explanation: Dorsal nerve, branch of pudendal, provides primary sensory supply to glans.
8) Frenulum attaches glans to?
a) Prepuce
b) Urethral sphincter
c) Scrotal skin
d) Raphe
Answer: a) Prepuce
Explanation: Frenulum is a fold anchoring prepuce to the ventral glans.
9) Erectile tissue most responsible for penile rigidity?
a) Corpus spongiosum
b) Corpora cavernosa
c) Glans penis
d) Superficial perineal fascia
Answer: b) Corpora cavernosa
Explanation: Cavernosa fill under high pressure, producing rigidity; spongiosum prevents urethral collapse.
10) Peyronie disease affects which penile structure?
a) Tunica albuginea
b) Urethral epithelium
c) Dartos muscle
d) Glans mucosa
Answer: a) Tunica albuginea
Explanation: Fibrosis of tunica albuginea leads to penile curvature.
11) Dorsal vein of penis drains into?
a) Prostatic venous plexus
b) External iliac vein
c) Inferior epigastric vein
d) Portal vein
Answer: a) Prostatic venous plexus
Explanation: Deep dorsal vein drains into prostatic plexus, clinically important in infections and metastasis.
Chapter: Upper Gastrointestinal Tract; Topic: Esophagus; Subtopic: Upper Esophageal Sphincter & Associated Muscles
Keyword Definitions:
Upper Esophageal Sphincter (UES): Functional sphincter formed mainly by cricopharyngeus muscle.
Cricopharyngeus: Lower part of inferior constrictor acting as UES and relaxing during swallowing.
Stylopharyngeus: Longitudinal muscle elevating pharynx during swallowing.
Thyropharyngeus: Upper part of inferior constrictor producing peristaltic contraction.
Swallowing Reflex: Coordinated relaxation of UES followed by peristaltic wave.
1) Lead Question – 2016
Which muscle causes opening of the upper end of esophagus?
a) Epiglottis
b) Thyropharyngeus
c) Stylopharyngeus
d) Cricopharyngeus of inferior constrictor
Answer: d) Cricopharyngeus of inferior constrictor
Explanation: The upper esophageal sphincter is primarily formed by the cricopharyngeus muscle, which tonically contracts to prevent air entry into the esophagus. During swallowing, this muscle must relax to allow passage of the bolus. The epiglottis plays no active muscular role. Thyropharyngeus creates pharyngeal peristaltic contractions, and stylopharyngeus elevates the pharynx but does not open the UES. Therefore, relaxation of the cricopharyngeus is responsible for opening the upper esophagus.
2) Killian’s dehiscence is located between?
a) Thyropharyngeus and cricopharyngeus
b) Superior and middle constrictor
c) Cricopharyngeus and stylopharyngeus
d) Middle and inferior constrictor
Answer: a) Thyropharyngeus and cricopharyngeus
Explanation: Killian’s dehiscence is a weak area where Zenker’s diverticulum commonly occurs.
3) True upper esophageal sphincter is formed by?
a) Cricopharyngeus
b) Stylopharyngeus
c) Salpingopharyngeus
d) Thyrohyoid membrane
Answer: a) Cricopharyngeus
Explanation: Cricopharyngeus maintains tonic contraction and relaxes during swallowing.
4) A patient with dysphagia and regurgitation of undigested food has Zenker’s diverticulum. Site of pathology?
a) Killian’s dehiscence
b) Laimer’s triangle
c) Vallecula
d) Piriform recess
Answer: a) Killian’s dehiscence
Explanation: Zenker’s arises between thyropharyngeus and cricopharyngeus.
5) Motor supply to pharyngeal constrictor muscles is via?
a) Glossopharyngeal
b) Vagus nerve via pharyngeal plexus
c) Accessory nerve
d) Hypoglossal nerve
Answer: b) Vagus nerve via pharyngeal plexus
Explanation: Except stylopharyngeus, all pharyngeal muscles receive vagal motor fibers.
6) Which muscle elevates the pharynx during swallowing?
a) Cricopharyngeus
b) Stylopharyngeus
c) Thyropharyngeus
d) Constrictor externus
Answer: b) Stylopharyngeus
Explanation: Glossopharyngeal-supplied stylopharyngeus is the main elevator.
7) Laimer’s triangle is a weak area below?
a) Cricopharyngeus
b) Thyropharyngeus
c) Superior constrictor
d) Stylopharyngeus
Answer: a) Cricopharyngeus
Explanation: Site prone for esophageal herniations and pulsion diverticula.
8) Sensory supply to upper esophagus?
a) Glossopharyngeal
b) Vagus
c) Hypoglossal
d) Accessory
Answer: b) Vagus
Explanation: Upper esophagus receives vagal sensory fibers mediating swallowing reflex.
9) Failure of UES to relax results in?
a) Achalasia
b) Cricopharyngeal spasm
c) GERD
d) Esophageal web
Answer: b) Cricopharyngeal spasm
Explanation: Cricopharyngeal dysfunction leads to dysphagia and high UES pressure.
10) During swallowing, which phase opens the UES?
a) Oral voluntary
b) Pharyngeal phase
c) Esophageal phase
d) Gastric phase
Answer: b) Pharyngeal phase
Explanation: Relaxation of cricopharyngeus occurs in the reflex-driven pharyngeal phase.
11) Muscle responsible for peristalsis in upper esophagus?
a) Skeletal muscle of esophagus
b) Smooth muscle only
c) Cricopharyngeus only
d) Diaphragmatic crura
Answer: a) Skeletal muscle of esophagus
Explanation: Upper one-third is skeletal muscle producing coordinated voluntary-initiated peristalsis.
Chapter: Peritoneum & Peritoneal Spaces; Topic: Lesser Sac (Omental Bursa)
Subtopic: Posterior Gastric Perforation & Peritoneal Collections
Keyword Definitions:
Lesser Sac (Omental Bursa): Peritoneal cavity behind stomach and lesser omentum.
Greater Sac: Main peritoneal compartment excluding the omental bursa.
Pouch of Morrison: Hepatorenal recess located between liver and right kidney.
Subphrenic Spaces: Pockets beneath diaphragm on both sides.
Posterior Gastric Perforation: Leakage of gastric contents through posterior wall into lesser sac.
1) Lead Question – 2016
Posterior perforation of stomach, collection of contents occurs in which pouch?
a) Greater sac
b) Left subhepatic and hepatorenal spaces (pouch of Morrison)
c) Omental bursa
d) Right subphrenic space
Answer: c) Omental bursa
Explanation: A posterior gastric perforation escapes into the space immediately behind the stomach—the omental bursa (lesser sac). This space lies between the stomach and pancreas. While anterior perforations spill into the greater sac, posterior perforations first collect in the lesser sac and may later leak through the epiploic foramen into other recesses. Subhepatic or Morrison’s pouch collections usually occur in generalized peritonitis, not in isolated posterior perforation. Thus, the earliest collection is in the omental bursa.
2) The lesser sac communicates with the greater sac through?
a) Pyloric canal
b) Epiploic foramen
c) Hepatorenal recess
d) Gastrocolic ligament
Answer: b) Epiploic foramen
Explanation: The epiploic (Winslow’s) foramen forms the only natural communication between both sacs.
3) Structure forming anterior boundary of epiploic foramen?
a) IVC
b) Caudate lobe
c) Hepatoduodenal ligament
d) Portal vein only
Answer: c) Hepatoduodenal ligament
Explanation: This ligament contains portal triad and forms anterior boundary of the foramen.
4) Posterior perforation of duodenum initially leaks into?
a) Lesser sac
b) Morrison’s pouch
c) Pararenal space
d) Pelvic cavity
Answer: c) Pararenal space
Explanation: Duodenal posterior ulcer perforation often leaks retroperitoneally.
5) Fluid in Morrison’s pouch is best seen in which position?
a) Supine
b) Prone
c) Left lateral
d) Right lateral
Answer: a) Supine
Explanation: Morrison’s pouch becomes the most dependent area in supine patients.
6) A patient with pancreatitis shows fluid behind the stomach. Most likely space?
a) Greater sac
b) Omental bursa
c) Pelvic cavity
d) Right subhepatic space
Answer: b) Omental bursa
Explanation: Pancreatic exudate often collects in the lesser sac due to anatomical position.
7) Posterior wall of lesser sac is formed by?
a) Lesser omentum
b) Transverse mesocolon
c) Parietal peritoneum over pancreas
d) Liver
Answer: c) Parietal peritoneum over pancreas
Explanation: The pancreas forms the posterior boundary covered by peritoneum.
8) In perforated peptic ulcer, free air under diaphragm indicates air in?
a) Lesser sac
b) Greater sac
c) Retroduodenal space
d) Pelvis
Answer: b) Greater sac
Explanation: Air rises under diaphragm after anterior perforations spilling into the greater sac.
9) Which ligament forms part of the roof of the lesser sac?
a) Gastrosplenic ligament
b) Hepatogastric ligament
c) Hepatorenal ligament
d) Splenorenal ligament
Answer: b) Hepatogastric ligament
Explanation: Part of the lesser omentum forms the superior boundary of the omental bursa.
10) Accumulation of pus in the lesser sac is termed?
a) Peritonitis
b) Lesser sac abscess
c) Subphrenic abscess
d) Interloop abscess
Answer: b) Lesser sac abscess
Explanation: Posterior gastric ulcers commonly lead to lesser sac abscess formation.
11) Gastrocolic ligament forms which wall of lesser sac?
a) Anterior
b) Posterior
c) Superior
d) Inferior
Answer: a) Anterior
Explanation: The stomach and gastrocolic ligament constitute the anterior boundary of the lesser sac.
Chapter: Anterior Abdominal Wall & Inguinal Canal; Topic: Cremaster Muscle; Subtopic: Fascia & Muscular Derivatives of the Inguinal Region
Keyword Definitions:
Cremaster Muscle: Thin muscle layer covering spermatic cord; elevates testes.
Internal Oblique: Middle layer abdominal muscle contributing to spermatic cord coverings.
Spermatic Cord: Cord-like structure carrying vas deferens, vessels, and nerves.
Cremasteric Reflex: Reflex elevation of testes mediated by genital branch of genitofemoral nerve.
Inguinal Canal: Oblique passage in lower abdominal wall transmitting spermatic cord or round ligament.
1) Lead Question – 2016
Cremastric muscle is formed from?
a) Fascia from internal oblique
b) Fascia from external oblique
c) Fascia from rectus abdominis
d) Fascia from transversus abdominis
Answer: a) Fascia from internal oblique
Explanation: The cremaster muscle and cremasteric fascia arise from fibers of the internal oblique muscle. As the testes descend through the inguinal canal, a portion of the internal oblique is drawn into the spermatic cord to form these structures. The external oblique forms the external spermatic fascia, whereas the transversus abdominis contributes no muscle to the cord because it arches above it. Hence, the cremaster is solely derived from internal oblique muscle fibers.
2) Cremasteric reflex afferent limb is via?
a) Ilioinguinal nerve
b) Genital branch of genitofemoral nerve
c) Femoral branch of genitofemoral nerve
d) Pudendal nerve
Answer: a) Ilioinguinal nerve
Explanation: The afferent sensory limb arises from the ilioinguinal nerve, while efferent is via genital branch of genitofemoral nerve.
3) Cremasteric reflex is absent in?
a) Upper motor neuron lesion
b) L1 nerve root injury
c) Hypothyroidism
d) Cauda equina lesion
Answer: b) L1 nerve root injury
Explanation: Reflex depends on L1–L2 segment integrity; L1 damage abolishes it.
4) Which is a derivative of external oblique aponeurosis?
a) External spermatic fascia
b) Cremaster muscle
c) Conjoint tendon
d) Tunica vaginalis
Answer: a) External spermatic fascia
Explanation: The external spermatic fascia arises from the external oblique aponeurosis.
5) Transversus abdominis contributes to spermatic cord covering as?
a) Cremaster muscle
b) Conjoint tendon
c) Transversalis fascia
d) It contributes nothing
Answer: d) It contributes nothing
Explanation: The transversus abdominis arches above the canal and gives no covering.
6) Injury to genital branch of genitofemoral nerve results in?
a) Absent cremasteric reflex
b) Loss of thigh adduction
c) Loss of scrotal sensation
d) Foot drop
Answer: a) Absent cremasteric reflex
Explanation: This branch provides the motor supply to the cremaster muscle.
7) Dartos muscle is derived from?
a) Smooth muscle of scrotal skin
b) Internal oblique
c) Transversalis fascia
d) External oblique
Answer: a) Smooth muscle of scrotal skin
Explanation: Dartos is a thin smooth-Muscle layer important for thermoregulation.
8) Deep inguinal ring is an opening in?
a) External oblique aponeurosis
b) Transversalis fascia
c) Internal oblique
d) Scarpa’s fascia
Answer: b) Transversalis fascia
Explanation: The deep ring is a defect in the transversalis fascia near midpoint of inguinal ligament.
9) Conjoint tendon is formed by fusion of?
a) External and internal oblique
b) Internal oblique and transversus abdominis
c) Rectus abdominis and external oblique
d) Transversalis fascia and internal oblique
Answer: b) Internal oblique and transversus abdominis
Explanation: Conjoint tendon supports the posterior wall of inguinal canal.
10) Covering of spermatic cord that originates from transversalis fascia?
a) Cremasteric fascia
b) Dartos muscle
c) Internal spermatic fascia
d) External spermatic fascia
Answer: c) Internal spermatic fascia
Explanation: This fascia lies deepest and arises from transversalis fascia.
11) Main action of cremaster muscle?
a) Elevation of testes
b) Depression of testes
c) Regulation of penile erection
d) Scrotal skin tightening
Answer: a) Elevation of testes
Explanation: Cremaster elevates testes during cold exposure or protective reflex.
Chapter: Retroperitoneum; Topic: Kidney Coverings; Subtopic: Renal Fascia (Gerota’s Fascia)
Keyword Definitions:
Gerota’s Fascia: Fibrous renal fascia enclosing kidney and adrenal gland.
Perirenal Fat: Fat layer immediately surrounding the kidney within Gerota’s fascia.
Pararenal Fat: Fat outside renal fascia providing extra cushioning.
Renal Capsule: Dense fibrous layer directly covering kidney surface.
Retroperitoneum: Space behind peritoneum containing kidneys, ureters, adrenals.
1) Lead Question – 2016
Kidney is covered by what fascia?
a) Sibson's fascia
b) Buck's fascia
c) Gerota's fascia
d) None
Answer: c) Gerota's fascia
Explanation: The kidney is enclosed by three major coverings: the renal capsule, perirenal fat, and Gerota’s fascia, also called the renal fascia. Gerota’s fascia forms a tough connective-tissue sheath around the kidney and adrenal gland, anchoring them to posterior abdominal structures. Sibson’s fascia is cervical, and Buck’s fascia belongs to the penis; hence, neither covers the kidney. The fascia is crucial for limiting the spread of perinephric infections and maintaining renal position within the retroperitoneum.
2) Perirenal fat is located?
a) Inside renal capsule
b) Between capsule and renal fascia
c) Outside Gerota’s fascia
d) Only at upper pole
Answer: b) Between capsule and renal fascia
Explanation: Perirenal fat forms a major protective cushion around each kidney.
3) Pararenal fat lies?
a) Deep to renal capsule
b) Deep to Gerota’s fascia
c) Superficial to Gerota’s fascia
d) Between cortex and medulla
Answer: c) Superficial to Gerota’s fascia
Explanation: Pararenal fat occupies the outermost layer, supporting the kidneys.
4) Renal capsule is?
a) Peritoneal lining
b) Tough fibrous coat of kidney
c) Layer of fascia surrounding adrenal only
d) Loose areolar tissue
Answer: b) Tough fibrous coat of kidney
Explanation: It adheres closely to renal parenchyma and protects from infection.
5) Which structure shares Gerota’s fascia with kidney?
a) Pancreas
b) Adrenal gland
c) Gall bladder
d) Duodenum
Answer: b) Adrenal gland
Explanation: Kidney and ipsilateral adrenal lie together within same fascial compartment.
6) Perinephric abscess is limited by?
a) Parietal peritoneum
b) Renal capsule
c) Gerota’s fascia
d) Iliac fascia
Answer: c) Gerota’s fascia
Explanation: Gerota’s fascia restricts spread superiorly and inferiorly, localizing abscesses.
7) Which muscle lies posterior to kidney?
a) Psoas major
b) Rectus abdominis
c) Iliacus
d) Internal oblique
Answer: a) Psoas major
Explanation: Posterior relations include psoas major, quadratus lumborum, and diaphragm.
8) Kidney is located at which vertebral level?
a) T8–T10
b) T12–L3
c) L3–L5
d) T6–T8
Answer: b) T12–L3
Explanation: Right kidney lies slightly lower due to liver size above it.
9) Which structure lies anterior to right kidney?
a) Stomach
b) Spleen
c) Liver
d) Tail of pancreas
Answer: c) Liver
Explanation: Right kidney contacts liver, duodenum, right colic flexure.
10) Which structure lies anterior to left kidney?
a) Duodenum
b) Liver
c) Jejunum
d) Ascending colon
Answer: c) Jejunum
Explanation: Left kidney relations include stomach, spleen, pancreas, jejunum.
11) Renal fascia blends inferiorly with?
a) Pelvic diaphragm
b) Iliac fascia
c) Transversalis fascia
d) Pouch of Douglas
Answer: b) Iliac fascia
Explanation: Inferior continuation helps anchor kidney within retroperitoneum.
Chapter: Urinary System; Topic: Ureter Anatomy; Subtopic: Anatomical Constrictions of the Ureter
Keyword Definitions:
Ureter: Muscular tube carrying urine from kidney to bladder.
Ureteric Constrictions: Narrow points where obstruction (stones) commonly occurs.
Pelviureteric Junction (PUJ): Junction of renal pelvis and ureter; one of the narrowest points.
Pelvic Brim: Area where ureter crosses external iliac vessels.
Vesicoureteric Junction (VUJ): Entry of ureter into bladder; the narrowest ureteric site.
1) Lead Question – 2016
Narrowest part of ureter is ?
a) Brim of the pelvis
b) Crossing by gonadal vessels
c) Vesicouretric junction
d) Crossing by ductus deferens
Answer: c) Vesicoureteric junction
Explanation: The ureter has three classical narrowings: the pelviureteric junction (PUJ), the crossing of the iliac vessels at the pelvic brim, and the vesicoureteric junction (VUJ). Among these, the VUJ is the *narrowest* physiologic point and is the most common site for ureteric stone impaction. At this junction, the ureter enters the bladder in an oblique intramural course offering high resistance. Other options represent relative constrictions, but none is as narrow as the VUJ.
2) Most common site of ureteric stone impaction?
a) PUJ
b) Pelvic brim
c) VUJ
d) Mid ureter
Answer: c) VUJ
Explanation: The VUJ has the smallest lumen.
3) Ureter is lined by?
a) Stratified squamous
b) Transitional epithelium
c) Cuboidal
d) Pseudostratified
Answer: b) Transitional epithelium
Explanation: Urothelium allows stretch.
4) Ureter crosses which vessel at pelvic brim?
a) Internal iliac artery
b) External iliac artery
c) Inferior epigastric artery
d) Obturator artery
Answer: b) External iliac artery
Explanation: Classical pelvic landmark.
5) Blood supply to upper ureter from?
a) Renal artery
b) Superior rectal artery
c) Gonadal artery
d) Obturator artery
Answer: a) Renal artery
Explanation: Segmental branches supply the upper third.
6) Ureter crosses ductus deferens in?
a) Abdomen
b) Pelvis
c) Perineum
d) Inguinal canal
Answer: b) Pelvis
Explanation: Near the bladder base.
7) Normal length of adult ureter?
a) 10 cm
b) 15 cm
c) 25–30 cm
d) 40 cm
Answer: c) 25–30 cm
Explanation: Extends from renal pelvis to urinary bladder.
8) Pain from upper ureter radiates to?
a) Perineum
b) Flank
c) Testis/labia
d) Suprapubic area
Answer: b) Flank
Explanation: T10–T12 dermatomal referral.
9) Ureteric peristalsis is chiefly regulated by?
a) Sympathetic nerves
b) Parasympathetic nerves
c) Intrinsic pacemaker cells
d) Voluntary control
Answer: c) Intrinsic pacemaker cells
Explanation: Ureter contracts independently of autonomic control.
10) Ureter is retroperitoneal?
a) Yes
b) No
c) Intraperitoneal
d) Subperitoneal
Answer: a) Yes
Explanation: Entire ureter lies within retroperitoneum.
11) Ureter enters bladder wall at what angle?
a) Vertical
b) Horizontal
c) Oblique
d) Curved
Answer: c) Oblique
Explanation: Oblique entry prevents vesicoureteral reflux.
Chapter: Gastrointestinal System; Topic: Large Intestine; Subtopic: Anatomy of the Colon
Keyword Definitions:
Colon: Part of the large intestine extending from cecum to rectum.
Haustra: Sacculations of colon formed by teniae coli.
Teniae Coli: Three longitudinal muscle bands on colon.
Cecum: First part of large intestine located in right iliac fossa.
Descending Colon: Retroperitoneal portion of colon on the left side.
Sigmoid Colon: S-shaped part of colon leading to rectum.
1) Lead Question – 2016
What is the total length of the colon?
a) 1 metre
b) 1.5 metres
c) 2 metres
d) 4 metres
Answer: b) 1.5 metres
Explanation: The colon extends from the cecum to the rectosigmoid junction and measures approximately 1.5 meters in adults. The ascending, transverse, descending, and sigmoid segments collectively form this length, although variations may occur. Knowing its length is clinically important in colonoscopy, radiology, and surgical resections. Longer lengths are more typical of the small intestine, while shorter values do not account for the full colonic segments. Thus, option (b) correctly represents the average length of the human colon.
2) Which part of colon is retroperitoneal?
a) Transverse colon
b) Sigmoid colon
c) Ascending colon
d) Cecum
Answer: c) Ascending colon
Explanation: Ascending and descending colon are retroperitoneal.
3) Teniae coli converge at?
a) Cecum
b) Rectum
c) Splenic flexure
d) Hepatic flexure
Answer: b) Rectum
Explanation: They spread out and disappear at rectum.
4) Blood supply of sigmoid colon?
a) Middle colic artery
b) Right colic artery
c) Sigmoid arteries
d) Ileocolic artery
Answer: c) Sigmoid arteries
Explanation: Branches of IMA supply sigmoid.
5) Common site of volvulus?
a) Cecum
b) Transverse colon
c) Descending colon
d) Sigmoid colon
Answer: d) Sigmoid colon
Explanation: Long mesentery predisposes to twisting.
6) Lymph drainage of descending colon?
a) SMA nodes
b) IMA nodes
c) Celiac nodes
d) Hepatic nodes
Answer: b) IMA nodes
Explanation: It drains to inferior mesenteric group.
7) Pain from splenic flexure referred to?
a) Epigastrium
b) Left hypochondrium
c) Umbilicus
d) Suprapubic
Answer: b) Left hypochondrium
Explanation: Due to its anatomical position near spleen.
8) Feature absent in colon?
a) Haustra
b) Villi
c) Teniae coli
d) Omental appendices
Answer: b) Villi
Explanation: Colon lacks villi unlike small intestine.
9) Which flexure is higher?
a) Hepatic
b) Splenic
c) Both equal
d) None
Answer: b) Splenic
Explanation: Splenic flexure is more superior and fixed.
10) Colon develops from?
a) Foregut
b) Midgut and hindgut
c) Hindgut only
d) Midgut only
Answer: b) Midgut and hindgut
Explanation: Right colon from midgut; left colon from hindgut.
11) Nerve supply to descending colon is via?
a) Pelvic splanchnic nerves
b) Vagus nerve
c) Thoracic splanchnic nerves
d) Recurrent laryngeal nerve
Answer: a) Pelvic splanchnic nerves
Explanation: Parasympathetic supply from S2–S4.
Chapter: Head & Neck Anatomy; Topic: Lymphatic Drainage; Subtopic: Submandibular Lymph Nodes
Keyword Definitions:
Submandibular Lymph Nodes: Nodes located beneath the mandible draining major facial areas.
Facial Lymph Drainage: Network collecting lymph from eyelids, cheeks, lips, and oral cavity.
Buccal Region: Cheek area containing superficial lymphatics.
Lower Lip Drainage: Central part drains to submental nodes, lateral parts to submandibular nodes.
Forehead Drainage: Mainly into preauricular and parotid nodes.
Periorbital Region: Medial eyelid lymph flows to submandibular nodes.
1) Lead Question – 2016
Submandibular lymph nodes drain the following areas of the face except?
a) Medial half of eyelids
b) Central part of lower lip
c) Medial part of cheek
d) Central part of forehead
Answer: d) Central part of forehead
Explanation: Submandibular lymph nodes primarily drain the medial half of eyelids, medial cheek, lateral lower lip, and lateral parts of the nose. However, the central part of the forehead drains into the preauricular and parotid lymph nodes, not the submandibular group. This distinction is essential in head and neck oncology and tracking lymphatic spread of infections or malignancies. Hence, the only area listed that does not drain into the submandibular lymph nodes is the central portion of the forehead, making option (d) correct.
2) Which lymph nodes drain the tip of the tongue?
a) Submandibular nodes
b) Submental nodes
c) Deep cervical nodes
d) Parotid nodes
Answer: b) Submental nodes
Explanation: The tip of the tongue drains to submental lymph nodes.
3) Lymph from palatine tonsil drains mainly into?
a) Jugulodigastric node
b) Submandibular node
c) Submental node
d) Retropharyngeal node
Answer: a) Jugulodigastric node
Explanation: Primary drainage is to the jugulodigastric node.
4) Central lower lip drains into?
a) Submandibular
b) Submental
c) Parotid
d) Buccal
Answer: b) Submental
Explanation: Midline structures often drain to submental nodes.
5) Lymph from lateral nose drains to?
a) Submental
b) Submandibular
c) Parotid
d) Mastoid
Answer: b) Submandibular
Explanation: Submandibular nodes receive lymph from lateral nose.
6) Preauricular lymph nodes drain?
a) Scalp anterior to ear
b) Tongue
c) Lower lip
d) Hard palate
Answer: a) Scalp anterior to ear
Explanation: Preauricular nodes drain forehead and anterior scalp.
7) Lymphatics of cheek primarily drain to?
a) Submental nodes
b) Parotid nodes
c) Submandibular nodes
d) Retropharyngeal nodes
Answer: c) Submandibular nodes
Explanation: Cheek drainage routes mainly to submandibular nodes.
8) Infection from central forehead spreads first to?
a) Submandibular nodes
b) Parotid nodes
c) Submental nodes
d) Jugular nodes
Answer: b) Parotid nodes
Explanation: Because the forehead drains to the parotid group.
9) Drainage of upper lip is mainly into?
a) Submandibular
b) Submental
c) Parotid
d) Retropharyngeal
Answer: a) Submandibular
Explanation: Most upper lip lymphatics reach submandibular nodes.
10) Lymph from the floor of mouth drains into?
a) Submental
b) Submandibular
c) Parotid
d) Occipital
Answer: a) Submental
Explanation: Floor of mouth drains into submental nodes.
11) Which node drains the lateral eyelid?
a) Parotid
b) Submandibular
c) Submental
d) Mastoid
Answer: a) Parotid
Explanation: Lateral eyelid lymphatics drain to parotid nodes.